LifeStance Health Group (NASDAQ:LFST) reported fourth-quarter and full-year 2025 results that management said exceeded expectations across key metrics, highlighting accelerating clinician productivity, continued clinician base expansion, and record profitability and cash flow generation. Executives emphasized operational initiatives aimed at filling available clinician capacity, disciplined technology investments, and a 2026 outlook that calls for continued growth and further margin expansion.
2025 performance: growth, profitability milestones, and record cash flow
Chief Executive Officer Dave Bourdon characterized 2025 as an “exceptional year,” citing “robust organic revenue and visit growth” driven by both clinician growth and improved productivity. The company said its team of roughly 8,000 clinicians delivered care to more than 1 million patients and conducted nearly 9 million visits during the year.
Chief Financial Officer Ryan McGroarty said fourth-quarter results topped internal expectations. Revenue grew 17% year-over-year to $382 million, aided primarily by better-than-expected total revenue per visit and, to a lesser extent, visit volumes. Visit volumes were 2.4 million, up 18% year-over-year, with management attributing outperformance primarily to clinician productivity. Visits per average clinician increased 7% year-over-year in the quarter.
For the full year, LifeStance reported revenue of $1.424 billion, up 14% year-over-year, which McGroarty said was “driven entirely by visit volumes.” Total revenue per visit in the fourth quarter was $160, described as roughly flat year-over-year and modestly ahead of expectations.
Profitability improved as well. Fourth-quarter center margin was $126 million, up 15% year-over-year, representing 33% of revenue. Adjusted EBITDA was $49 million, up 49% year-over-year, and Adjusted EBITDA margin reached 12.8%, which management called the highest in the company’s history as a public company. For the full year, Adjusted EBITDA was $158 million, up 32% year-over-year, with margin expanding 150 basis points to 11.1%.
McGroarty also noted that LifeStance delivered positive net income and earnings per share for the full year, reaching the milestone “a year earlier than we expected.”
On cash flow, the company generated $47 million in free cash flow in the fourth quarter and $110 million for the full year, exceeding expectations due to better-than-expected earnings and collections performance. LifeStance ended the quarter with $249 million in cash and net long-term debt of $266 million, plus an undrawn $100 million revolver. Management cited net and gross leverage of 0.2x and 1.8x, respectively.
Clinician expansion and productivity: balancing capacity and hiring
LifeStance ended 2025 with 8,040 clinicians, up 9% year-over-year, after adding 657 net clinicians for the year and 44 in the fourth quarter. McGroarty said the fourth-quarter pace reflected an intentional strategy to balance existing clinician capacity with new hiring, which he said was validated by the quarter’s visit and revenue performance.
Bourdon and McGroarty repeatedly returned to productivity improvements as a central theme, particularly in the second half of 2025. Bourdon said operational initiatives were not a one-quarter lift, noting the impact “build into Q4” and continued into early 2026.
In response to questions about the drivers of higher visits per clinician, Bourdon described a two-part dynamic: clinicians provided more appointment availability, and LifeStance focused on better filling that capacity. He cited schedule optimization and practice management initiatives, as well as efforts to increase new patient flow by improving appointment conversion.
Technology and AI initiatives, including EHR transition plans
Management described 2025 as a year of “targeted, practical” deployment of digital and AI tools to support patient access, clinician experience, and operational efficiency. Bourdon said the company implemented an AI solution to assist its scheduling team for new patient phone booking, contributing to stronger conversion and efficiency. He also said AI tools deployed in this area improved phone-to-appointment conversion by 5%.
LifeStance also piloted AI-assisted clinician documentation, with Bourdon citing early results showing reduced administrative burden and “cognitive load,” enabling clinicians to work more efficiently. Management also referenced digital check-in, AI, and robotic process automation as tools supporting revenue cycle management and cash collections.
Looking ahead, Bourdon said the company completed its EHR discovery process and selected a new “best-in-class” vendor, framing the transition as foundational to long-term clinical and operational excellence. He said the new EHR is expected to improve interoperability, support health system partnerships, enhance workflows, and enable integration with AI point solutions. Implementation work will begin in 2026, with a transition expected during 2027. In Q&A, Bourdon said the company would not name its current or future EHR vendors on the call.
McGroarty said the EHR implementation is expected to represent a cash use of roughly $20 million to $30 million across 2026 and 2027, with much of the spend capitalized or treated as non-recurring and adjusted through EBITDA. He added that any P&L impact was already reflected in 2026 guidance.
Capital allocation: $100 million share repurchase and disciplined M&A
LifeStance announced a board-authorized share repurchase program of up to $100 million, funded with cash on hand. McGroarty described the buyback as an “attractive and highly efficient way to deploy capital.”
Management also reiterated that M&A remains a priority, but said there is no material M&A included in 2026 guidance. Bourdon said the company is seeing valuation expectations among larger targets in the $75 million to $250 million revenue range that are “dislocated from reality,” while smaller “downmarket” opportunities appear more appropriately valued. He said the company is targeting those smaller tuck-ins primarily for geographic expansion and does not see small acquisitions in geographies where it already has meaningful presence, noting organic growth economics are more attractive in those markets.
2026 outlook: volume-driven growth, modest rate lift, and further margin expansion
For 2026, management guided to full-year revenue of $1.615 billion to $1.655 billion, center margin of $526 million to $550 million, and Adjusted EBITDA of $185 million to $205 million. McGroarty said the midpoint implies an 11.9% Adjusted EBITDA margin, “almost a point of margin expansion.”
Key elements of LifeStance’s 2026 assumptions included:
- Revenue growth primarily driven by higher visit volumes, with low to mid-single digit growth in total revenue per visit attributed to payer rate increases.
- Revenue phasing expected to be roughly 50/50 between the first and second half, with the second half slightly higher.
- First-quarter 2026 guidance of revenue between $380 million and $400 million, center margin between $118 million and $132 million, and Adjusted EBITDA between $39 million and $45 million, with seasonal pressure from higher payroll taxes.
- Stock-based compensation expected to be approximately $60 million to $70 million in 2026, with management noting the company is beginning to see the benefit of sunsetting clinician stock-based incentives in favor of cash bonuses.
- New center openings of 20 to 30 in 2026, which McGroarty said carry lower initial margin profiles but are contemplated in guidance and are expected to ramp to normal margins relatively quickly.
On payer dynamics, Bourdon said the company has largely completed an effort to “clean up” payer contracts, reducing the number of contracts by about 50% over the last three years to improve administrative efficiency. He said payer conversations have been constructive and expressed confidence in achieving low to mid-single digit rate increases, primarily through annual discussions, with multi-year arrangements used selectively.
In an additional growth area, Bourdon said LifeStance’s specialty services segment, previously described as about $50 million in revenue, is targeted to reach $70 million in revenue in 2026, driven primarily by treatment-resistant depression services such as SPRAVATO and TMS, which he described as low capital intensity due to leveraging existing centers.
The company also discussed referral channels and partnerships. Bourdon said LifeStance spends about 2% of revenue acquiring new patients, which he called efficient and enabled by referral programs with medical practices. On its relationship with Calm, he said it remains “early days,” is generating new patient volume, but is not meaningful enough to move 2026 results. He added that partnerships with digital players could bring a younger, more digitally native demographic.
Separately, LifeStance said Executive Chairman Ken Burdick will transition to non-executive chair of the board next month, citing board confidence in the current leadership team.
About LifeStance Health Group (NASDAQ:LFST)
LifeStance Health Group (NASDAQ:LFST) is a leading provider of outpatient mental health services in the United States. Headquartered in New York City, the company operates a growing network of clinics that deliver integrated, patient-centered psychological and psychiatric care. LifeStance’s mission is to expand access to high-quality mental health treatment by combining evidence-based therapy modalities with personalized treatment plans.
The company’s service offerings include individual, family, and group psychotherapy, psychiatric medication management, psychological assessment, and telehealth services.
