Asking for a bridge of year-over-year payer mix changes, specifically the impact of lower exchange revenue and IDR, and the outlook for payer mix in the second half.

Nick Loporcaro noted that the impact from ACA exchange subsidies started in Q2, with some patients shifting to self-pay or commercial plans, varying geographically. Brian Tierney confirmed that the exchange impact and the No Surprises Act year-over-year comparison are the main drivers of the payer mix shift, which is consistent with expectations and baked into guidance. “Yes, but it's the short answer. Your question is yes, it's the exchange impact and the No Surprises Act year-over-year comp that really drive the payer mix shift.”

Inquiring about the drivers behind the improved air capture rate, beyond just better weather in Q2.

Nick Loporcaro attributed it to technology, pilot/medical staff recruitment, and understanding demand. Ted Van Horne added that weather impacts in specific geographies where GMR has higher capture rates were a significant factor, along with ongoing investments in IFR aircraft. “Yes, and that quarter specific in Q2, the way the weather was impacting the good parts, different parts of geographies for us too. So where we see higher capture rates in certain parts of America, and that's where we're seeing a lot of the weather improvements and we saw the capture rates improve with that also.”

Asking about the current footprint of 911 Nurse Navigation, the ultimate target, and limiting factors for its rollout.

Nick Loporcaro stated 29 communities cover 19.7 million lives, with a potential to reach 100 million covered lives in a 5-year plan. Ted Van Horne outlined three growth channels: existing footprint expansion, Rural Health Transformation Fund bids, and large Metro models. He also mentioned opening a second center in Phoenix to increase capacity for nurses. “So, you know, we're probably 29 communities today of coverage representing just shy of 20 million covered lives. And I think you'll recall, and we talked about in our presentations, we have approximately 200 million lives in the geographies that we serve. So that's the potential.”

GMRS

GMR Solutions (GMRS) Q2 FY26 earnings call: guidance and Q&A

Earnings call· Jun 2026 (Q2 FY26)· Health Care· Aug 13, 2026

Source: earnings call transcript

Executive summary

GMR Solutions Q2 FY26 — Strong Performance Driven by Core Services and Innovation

GMR Solutions delivered strong underlying Q2 FY26 results, with revenue growth and operational improvements in core emergent services and innovative offerings like 911 Nurse Navigation. While adjusted EBITDA and net income were impacted by IPO-related expenses and a lower benefit from No Surprises Act claims compared to the prior year, the company reaffirmed its full-year guidance, demonstrating confidence in its integrated model and deleveraging trajectory. Management highlighted strategic focus on contract profitability, labor productivity, and resource utilization to sustain margins amidst ongoing payer mix shifts and fuel cost pressures.

Highlights

Q2 revenue grew 3.3% year-over-year to $1.49 billion.
911 Nurse Navigation calls increased 50% year-over-year to nearly 29,000, expanding to 29 communities covering 19.7 million lives.
Net leverage improved to 3.5x from 4.3x year-over-year, with a target of below 3.3x by year-end.
Air volumes increased 6.9% year-over-year due to strong demand and improved capture rates.
Same-market revenue increased $53.1 million, or 3.8% year-over-year.

Concerns

Adjusted EBITDA decreased 11.8% year-over-year to $285 million, impacted by a $74 million lower benefit from No Surprises Act claims compared to prior year.
Total operating expense increased 19.4% to $1.43 billion, driven by a 24.5% increase in employee wages, benefits, and taxes due to $129.6 million in stock compensation expense from the IPO.
Net loss of $28.3 million in the quarter, compared to net income of $80.8 million in prior year, primarily due to $142.3 million in IPO-related expenses.
Payer mix shift impact of approximately $16 million due to ACA exchange subsidy expiration, leading patients to shift from commercial insurance to self-pay.
Maintenance, fuel, and other direct expenses increased 21.1% to $136.4 million, driven by fuel unit costs due to the Iran conflict.

Guidance & targets

Category	Target	Timeline	Confidence
Full-year revenue	$5.89 billion to $6.18 billion high materiality	FY26	High
Full-year Adjusted EBITDA	$1.135 billion to $1.195 billion high materiality	FY26	High
Full-year total cash used for CapEx and aircraft financing	5.1% and 5.3% of total revenue medium materiality	FY26	High
Net leverage	below 3.3x high materiality	Year-end FY26	High
Net leverage	3.0x high materiality	before the end of 2027 · CY27	Medium
911 Nurse Navigation community expansion	4 more communities medium materiality	remainder of the year · FY26	High

GMRS operating KPIs by quarter

GMRS operating KPIs stated on its earnings calls, by fiscal quarter
KPI	Mar 2026 Q1 FY26	This call Jun 2026 Q2 FY26	Change vs prior quarter
Patients Ground medical services	1.3M+ We provided ground medical services to over 1.3 million patients, which includes more than 1 million transports, along with over 28,000 calls through our 911 Nurse Navigation offer. Source: earnings call transcript	1.3M+ We provided ground medical services to over 1.3 million patients, which includes more than 1 million transports, along with 29,000 calls to our 911 Nurse Navigation offering. Source: earnings call transcript	—
Patients Air Medical Services	34K+ During the quarter, we provided Air Medical Services to over 34,000 patients. Source: earnings call transcript	36K+ During the quarter, we provided air medical services to over 36,000 patients. Source: earnings call transcript	—

Operating figures the company stated on at least two of the calls shown, checked against each call's transcript. Click a figure to read the sentence. A dash means it was not stated that quarter.

Risks & headwinds

Payer mix shift due to ACA exchange subsidy expiration ongoing for remainder of FY26

$16 million impact in Q2 FY26

Mitigation:Included in guidance; studying geographic variations and potential levers like contract renegotiation.

Increased fuel unit costs due to Iran conflict ongoing for remainder of FY26

Maintenance, fuel, and other direct expenses up 21.1% to $136.4 million in Q2 FY26; $10+ million per quarter incremental fuel cost

Mitigation:Baked into guidance; minimizing deliveries and focusing on efficiency.

IPO-related expenses and stock compensation impacting net income and EBITDA comparability Q2 FY26

$142.3 million IPO-related expenses; $129.6 million stock compensation expense in Q2 FY26

Mitigation:One-time impacts, underlying business performance remains strong.

Health plan pushback on IDR process and volume of claims ongoing

IDR lower fees of $1-2 million annually

Mitigation:Continuing conversations with large payers to get them in-network; prepared to beat resistant payers in IDR.

Aircraft supplier delays FY26-FY27

Some aircraft deliveries pushed from FY26 to FY27 by a couple of months

Mitigation:Not material or meaningful in the long term; all will catch up.

What to watch in Q3 FY26

Net leverage reduction

Year-end FY26

Current 3.5x

Target Below 3.3x

Why it matters

Demonstrates capital efficiency and strengthens financial position, potentially enabling future M&A.

Net leverage finished the quarter at 3.5x, down from 4.3x at the end of 2Q last year. We expect strong cash flows to drive this below 3.3x by year-end and have line of sight to 3.0x before the end of the year in 2027.

Find out whether GMRS delivers this. Inve re-checks your case every morning.

Q&A highlights

Seeking more context on IDR dynamics, particularly the year-over-year change in Q2 and how it compares to Q1 and prior year sweeps.

Brian Tierney explained that Q2 FY25 had about $79 million in No Surprises Act-related change in estimates, while Q2 FY26 had only $5 million, creating a $74 million delta. This indicates improved estimation accuracy, with future estimates expected to be in the "0 plus or minus 5" range.

“Yes, last year in the second quarter we had about $79 million worth of change in estimate related to the No Surprises Act stuff. This year was about 5. So that drives that $74 million delta.”

asked by Scott Fidel · answered by Brian Tierney

2 min read 5 chapters

Detailed narrative

Integrated Care Model and Innovation

GMR differentiates itself through an integrated air and ground model, supported by technology solutions like 911 Nurse Navigation, Concierge, and Transport.net. These platforms enhance efficiencies, coordinate care across modalities, and improve resource utilization, leading to better patient outcomes and operational decision-making.

The 911 Nurse Navigation program, for instance, diverted up to 20% of medical calls to skilled nurses, improving resource allocation and reducing emergency department overcrowding.

Market Positioning and Growth Strategy

As the largest provider of emergency medical services, GMR serves 5.5 million patients annually across 46 states and Washington, D.C., covering over 60% of the U.S. population. The company operates in a $35 billion total addressable market, driven by an aging population, rising chronic disease prevalence, and rural healthcare facility closures.

GMR's growth strategy includes expanding in existing markets, entering new ones, cross-selling integrated offerings, and disciplined M&A.

Reimbursement and Regulatory Environment

GMR applauds the introduction of the Reimbursing Emergency Services for Critical Urgent Events (RESCUE) Act of 2026, which aims to modernize Medicare payment structures for EMS based on real cost data, potentially closing the financial gap between reimbursement and service costs.

The company continues to engage with states on rural healthcare access and EMS models, including initiatives like the 911 React platform for rural areas. Management noted that new IDR rules had little overall impact, with lower fees being a slight tailwind of $1-2 million annually.

Operational Discipline and Efficiency

The company's operating discipline focuses on contract profitability, labor productivity, resource utilization, and rate adequacy. Strategic review processes initiated in 2022 continue to guide portfolio focus on core operations and better-performing services, including renegotiating or exiting contracts that do not meet return thresholds.

Efficiency initiatives in billing, collections, staffing, and fleet utilization also contribute to margin sustainability, with 40-50 AI-related initiatives aimed at driving system efficiencies.

Payer Mix Dynamics and No Surprises Act

The company experienced a payer mix shift impact of approximately $16 million in Q2 FY26 due to the expiration of ACA exchange subsidies, leading some patients to self-pay. This was in line with expectations and included in prior guidance. The Q2 results also reflect a $74 million lower benefit from No Surprises Act claims compared to the prior year, indicating improved estimation accuracy for these claims, with future estimates expected to be in the "0 plus or minus 5" range.

Summary of the company's earnings call; see how call summaries are prepared. Not investment advice.