Waystar
Waystar runs the clearinghouse network that routes hospital and clinic bills to insurers for payment.
On the record
Checkpoint: Q2 2026 earnings, plus continued Iodine integration progress toward 2027 accretion
The call
Waystar sits deep inside hospital billing plumbing that neither Epic nor any AI startup has replaced, while private equity owners keep selling down their stakes.
It is hard to replace because hospitals and insurers have already plugged into its systems, switching costs are high, and the company keeps customers happy (they stick around and spend more over time). The real threat is not Epic Systems (which sells to hospitals but has not shipped a serious competitor in this space) or hypothetical AI-focused startups (which do not exist yet at scale), but rather whether Epic finally builds one, or whether an AI startup proves it can win major hospital customers. Right now there is no sign of either.
Why
01
AI pressure: None apparent. No AI-native RCM startup has won a reference hospital at scale; Waystar sells AI features on its own network instead. Could AI do the core job? Unlikely.
02
Bigger players: Epic Systems. Epic could push its EHR dominance into billing, but it has shipped no multi-payer clearinghouse rival yet. Could a giant copy it? No, they are blocked.
03
What protects it. A regulated network with 5,000+ payer links and 530+ hospital system integrations that took years to build and is costly to switch off.
What would change this call
Waystar's net revenue retention rate falling below 105% in a quarterly earnings report. Would show clients are trimming spend or defecting despite the entrenched clearinghouse network.
Epic Systems announcing or shipping a standalone multi-payer RCM/clearinghouse product. Would show the EHR incumbent leveraging its install base directly against Waystar's core business.
An AI-native RCM startup publicly named as winning a large-scale hospital system account (not a pilot). Would show a new model-based entrant actually converting Waystar-scale clients, not just marketing.
Epic Systems announcing or shipping a standalone multi-payer RCM/clearinghouse product. Would show the EHR incumbent leveraging its install base directly against Waystar's core business.
An AI-native RCM startup publicly named as winning a large-scale hospital system account (not a pilot). Would show a new model-based entrant actually converting Waystar-scale clients, not just marketing.
Key numbers
- 112% net revenue retention
- 43% adjusted EBITDA margin
- 7.5B+ transactions, 60% of US patients
Named risks
- AI-native RCM startup or Epic ships a credible multi-payer rival product eroding client base.
- Iodine Software integration slips, delaying accretion expected from 2027.
- PE holders (EQT, CPPIB, Bain) continue secondary sell-downs pressuring share price.
- Accelerating print-to-digital shift compresses volume-based revenue growth (only +7% YoY Q1 2026).
- LBO take-private speculation creates ownership uncertainty for employees and clients.
Rivals, as read in July 2026
| Rival | Direction | Evidence |
|---|---|---|
| R1 RCM | contesting | R1 taken private for $8.9B Nov 2024, serves 95 of top 100 US health systems, ~$2.1B revenue mid-2026 |
| Change Healthcare (Optum) | losing to | Waystar picked up share after Change Healthcare's 2024 cyberattack disrupted its book (2024-09-19) |
| Experian Health | contesting | KLAS 2026 report grades Experian B+ versus Waystar's top A grade (2026-07-22) |
| Epic Systems | contesting | Epic controls 42% of US EHR market but is structurally conflicted as single-EHR player in multi-payer RCM (2026-04-27) |
Questions people ask
- Is Waystar profitable in 2026?
- Yes. Waystar posted Q1 2026 net income of $43.3M on revenue of $313.9M (up 22% YoY) with a 43% adjusted EBITDA margin, per its April 29, 2026 earnings release. FY2026 guidance points to $1.274B-$1.294B in total revenue.
- Could AI replace Waystar's software?
- Unlikely soon. Waystar's moat rests on 7.5B+ annual transactions, 530+ hospital/PMS integrations, and 5,000+ payer connections plus HIPAA clearinghouse status; AI (AltitudeAI) is deployed on top of this network, with ~40% of new bookings tied to AI as of April 29, 2026.
- Who owns Waystar?
- Waystar went public on Nasdaq (WAY) June 7, 2024. Post-IPO, EQT held ~29.2%, CPP Investments ~22.3%, and Bain Capital ~16.8%. All three have since sold down via secondaries totaling over $1.26B in May and September 2025.
- Why has Waystar's stock fallen in 2026?
- As of July 22, 2026, Waystar's market cap was about $4.1B with shares trading $20-21, far below its $48.11 all-time high, driven by PE-holder secondary sell-downs and investor 'AI concerns' narrative despite accelerating 22% revenue growth.
- Who is Waystar's biggest competitor?
- R1 RCM is Waystar's closest large-scale rival, taken private for $8.9B in November 2024 and serving 95 of the top 100 US health systems with about $2.1B in revenue as of mid-2026. Experian Health and Availity also compete in claims/eligibility.
- Is Waystar laying off employees?
- Signals are mixed. Crustdata reported 1,778 employees as of June 2026 (up 14.1% YoY), while Revelio Labs reported 1,729 employees in December 2025, down 3.3% from 1,787 in 2024, suggesting flat-to-slightly-declining headcount rather than mass layoffs.
Timeline
- 2026-07-22KLAS 2026 RCM Suites report gives Waystar top overall grade (A) among suite vendors
- 2026-05-20Barclays says LBO take-private math 'increasingly compelling' given depressed valuation
- 2026-05-19Board authorizes $200M share repurchase program
- 2026-04-29Q1 2026 revenue $313.9M (+22% YoY), net income $43.3M, NRR ~112%
- 2026-04-23Spring Showcase adds agentic AI features and expanded Google Cloud partnership
- 2026-02-17FY2025 results: revenue ~$1.1B, up 17% YoY, first year over $1B
- 2026-01-12Waystar launches agentic AI capabilities within AltitudeAI
- 2025-10-02Iodine Software acquisition closes for $1.25B enterprise value
- 2025-07-23Waystar announces acquisition of Iodine Software
- 2024-06-07Waystar IPO on Nasdaq raises $968M at $21.50/share
Revision history
22 July 2026
First assessed. Hard to displace. The text above is fixed as of this date and is not edited afterwards.
In the same band
Sources
- Waystar Reports Fourth Quarter and Fiscal Year 2025 Results (2026-02-17)
- Waystar Reports First Quarter 2026 Results (2026-04-29)
- Waystar Announces $200 Million Share Repurchase Authorization (2026-05-19)
- KLAS Research Releases 2026 RCM Suites Report (2026-07-22)
- Health tech company Waystar raises $968M in IPO (2024-06-07)
- Healthcare software firm Waystar raises $968 million million in IPO (2024-06-06)
- Healthcare payments firm Waystar's shares slip in Nasdaq debut (2024-06-07)
- Waystar - Headcount, Funding & Open Jobs (2026-07-02)
- gurufocus.com (2026-07-22)
- Barclays cuts Waystar target, says LBO math 'increasingly compelling' (2026-05-20)
- RCM company Waystar buys Iodine Software for $1.25B (2025-10-03)
- Waystar Accelerates the Autonomous Revenue Cycle... (2026-04-23)