Waystar Holding Corp at Citi Global Healthcare Conference Transcript

The following is excerpted from the question-and-answer section of the transcript.

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Let's -- maybe if we can get started with just a little bit of level-setting for people who are newer to the Waystar story, you're still relatively new to the public markets. Can you just start by framing the core problem you're solving for health care providers? And in particular, the question that I get the most, mostly from people who are newer to the story, is about where you fit within the competitive dynamic, the competitive field, I should say, because it is quite crowded. Can you discuss the importance of being kind of an end-to-end platform and the more modular way you approach that end-to-end platform versus some of the more full-stack outsourcers?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Got it. So as you go to market, and we'll dig a bit deeper into the competitive dynamic later, but as you go to market, are you mostly replacing kind of these vendors that just haven't performed well? Or is it completely replacing very traditional, tool ways of doing things on paper? What are you --

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes, makes sense. I want to touch on one of your recent acquisitions, a large acquisition you made, the $1.25 billion acquisition of Iodine. This is really interesting because it kind of got you more into the clinical documentation setting. Can you just maybe talk a little bit about the value that Iodine is bringing to your end-to-end platform? Because I think as I look at your platform, it's pretty robust, but this is kind of a new step for you. And what opportunities does this specifically unlock for you?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : And can you talk a little bit about the AI models that Iodine also brings to your tech stack?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes. Let's talk about a little bit of a near-term dynamic. I think 4Q is typically one of the busier quarters from a sales cycle perspective. How has -- now that we're kind of nearing the end of 4Q, how has the sales cycle shaped up this year versus prior years? Are there any solutions that you're seeing kind of outsized demand for? I think you mentioned kind of the pre-auth and, I assume, denials too are big for you. But any solutions that this year have seen a marked change in demand?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Got it. Okay. And from the RFPs, is that mostly health systems, or is it really throughout -- you typically are bigger on the ambulatory space. But has the nature of the RFP -- who's running RFP changed as well? LSEG STREETEVENTS | www.lseg.com | Contact Us consent of LSEG. 'LSEG' and the LSEG logo are registered trademarks of LSEG and its affiliated companies. DECEMBER 03, 2025 / 6:45PM, WAY.OQ - Waystar Holding Corp at Citi Global Healthcare Conference

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Okay. Great. Utilization has been very strong for you guys for the past couple of years. I'm wondering, is this a temporary bump that you're seeing? Or is this more of a structural shift in the market that is durable for the next few years? And importantly, how does this impact the demand for your platform? And do you think it will intensify provider focus on revenue capture from that utilization?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes. We'll switch over to AI. We already mentioned it with Iodine and what that brings to your platform. But you also have a partnership with Google, and you've rolled out several generative AI products, the Altitude product suite, which is really interesting, I think one of the only ways to play the AI trade right now in health care in a real way. A lot of people talk about AI, but you're actually introducing products that have real AI in it. How are you pricing these products? And what has the early reception been to these products?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes. And is there any way to dimensionalize what percent of revenue or percent of clients have adopted some of these newer AI-driven technologies?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : And remind me, there are -- typically, I know every contract is a little bit different, but they're typically even for non-AI products, annual escalators. Can you frame what a typical annual escalator is? And then how perhaps the GenAI escalator compares to that?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes. Makes sense. Okay. And then looking ahead, what do you think is next for GenAI? Do you think you'll move to kind of an agentic AI product at some point? How should we think about the future of that product set?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Got it. Okay. So let's switch over to the competitive dynamic. As I alluded to, it's a very crowded field. And this is -- as I mentioned, probably one of the questions that I get asked most often, because you do seem to hear about a new company every week or so that is AI native revenue cycle management. You hear about what Epic and Cerner are doing on the revenue cycle management side, which has not typically been an area of strength for them, but they do tend to own, at least on the health system side, the tech stack. And then you've got your traditional competitors, which have always been around. How do you differentiate yourself among those different constituencies? And also, there is this dynamic to where you're partners with EHR companies. So it's this coopetition dynamic too that is playing out in the market. How do you maintain those strong relationships while also being a competitor?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes, makes sense. And I'm wondering though, do you think as AI becomes more prevalent, that this dynamic changes at all? And what I mean by that is I get a lot of questions also on how does -- and this isn't just for revenue cycle management, but you can ask this question for any vertical SaaS company, how does vertical SaaS operate in an AI dominated industry? And I'm thinking maybe we'll have this barbell effect where it does make it easier for health systems and larger ambulatory groups to in-source with AI tools and maybe it does make the EHRs a little bit better in terms of product quality or a little bit faster to market. Do you see that -- it's probably not here right now, but looking out a year or two-years from now, do you see AI changing the competitive dynamic and that barbelling effect?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Got it. Okay. And let's talk about some of that connectivity that you do have within the health care system. And when I think about you guys, you also have a big clearinghouse business, which has benefited from competitor disruption. Can you -- I don't think you've ever really sized the clearinghouse business, but is there any qualitative commentary around the size of that business that you can provide? And really, my question is with that disruption that came from your competitor, there's obviously a big upsell opportunity. And I think that was one of -- that has been one of the drivers of your very strong dollar-based retention. Can you just comment on the progress that you've made and if there's more juice to squeeze out of those clients?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Sizing the -- how big the clearinghouse is -- LSEG STREETEVENTS | www.lseg.com | Contact Us consent of LSEG. 'LSEG' and the LSEG logo are registered trademarks of LSEG and its affiliated companies. DECEMBER 03, 2025 / 6:45PM, WAY.OQ - Waystar Holding Corp at Citi Global Healthcare Conference

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes. Makes sense. One other industry dynamic that has come up this year is kind of an arms race between provider tech and payer tech. It does seem like provider tech, and maybe this is just a false narrative and searching for a narrative, but it does seem like provider tech has kind of gotten the upper hand this year at least, and perhaps next year we'll see payers invest more in their technology stacks to combat some of the headwinds they're facing on the MLR side. Are you seeing a similar dynamic or am I just searching for a narrative here? What's the tension been like between providers and payers as they invest in their technologies?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Would you ever consider getting more into payer tech, maybe through payment integrity or something like that?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Okay. Let's stick to the China opportunity you have in front of you then. You bought Iodine, which got you into kind of the clinical document management. You acquired a patient payment asset that got you more into patient payments. Looking forward, where do you see the most opportunity? And this could be organic or inorganic. But where do you see the most opportunity for either expansion into new products, new markets? What's next there?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Yes. What about ambient scribing? We hear a lot about the hype in that market. Any interest in those solutions.

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Got it. Okay. And let's turn to your guide, your '25 guide, which was strong. But to us, it does seem a bit conservative, maybe prudently conservative. If we assume an increase -- sequential increase in your subscription revenue, it implies kind of a mid-single-digit sequential drop in volume. Can you just remind us of the seasonality in the business and some of the building blocks of your '25 guide?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Got it. And we're just about out of time here, but I'd be remiss not to ask about 2026. I know you're not going to give formal guidance unless that is something you want to do. But I would like you to kind of help frame how we should be thinking about growth in '26. I think margins are pretty safe, but growth, I think, has been a bigger area of debate, particularly because you have had such -- and I'm talking about on an organic basis, such a nice organic growth over the last couple of years, above your targets. Maybe help decompose kind of the growth and bridge the growth from '25 to '26. Are there any temporary or non-recurring items in '25 we should be thinking about as we model out '26?

Question: Daniel Grosslight - Citi Infrastructure Investments LLC - Analyst : Great. Well, we are out of time now. Steve, thank you so much for all your time this afternoon. Super interesting.