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Astrana Health, Inc.: Q1 FY2026 earnings call

What management said about Q1 FY2026, from the documents filed with the SEC on 7 May 2026: press release. Guidance figures: 5 new, 9 kept. The quarter’s numbers.

Key takeaways

  • Revenue up 56% year over year: Total revenue was $965.1 million, against $620.4 million a year earlier, the company reported for the first quarter of 2026. Source
  • Adjusted EBITDA up 82%: Adjusted EBITDA was $66.3 million. The company defines the margin as Adjusted EBITDA over total revenue, and reported it at 7% against 6%. Source
  • Care Partners revenue up 51%: Care Partners revenue was $909.7 million and income from operations was $39.5 million, down 11% from a year earlier. It is the largest segment by revenue. Source
  • About 80% of capitation now full-risk: The company said about 80% of Care Partners capitation revenue and about 40% of consolidated membership are now in full-risk arrangements. Source
  • Net leverage fell to about 2.3x: Net leverage was about 2.3x on a pro forma trailing twelve-month basis and 2.2x on the midpoint of full-year guidance. The company said deleveraging is ahead of schedule. Source

“We had a strong start to 2026, delivering disciplined growth, strong medical cost performance, continued operating leverage, and early performance from new full-risk contracts in line with our expectations,”

Brandon Sim, President and Chief Executive Officer of Astrana Health

Guidance

AreaPeriodFigureAgainst last quarter
Total revenue Sourcethree months ending June 30, 2026$965 million to $1,000 millionNew
Adjusted EBITDA Sourcethree months ending June 30, 2026$65 million to $70 millionNew
Total revenue Sourceyear ending December 31, 2026$3,800 million to $4,100 millionKept
Adjusted EBITDA Sourceyear ending December 31, 2026$250 million to $280 millionKept
Free cash flow Sourceyear ending December 31, 2026$105 million to $132.5 millionNew
Net cash provided by operating activities Sourceyear ending December 31, 2026125,000 to 145,000 (in thousands)New
Purchases of property and equipment Sourceyear ending December 31, 2026(20,000) to (12,500) (in thousands, shown as cash used)New
Net income Sourceyear ending December 31, 202654,000 to 74,000 (in thousands)Kept
Interest expense Sourceyear ending December 31, 202651,000 to 55,000 (in thousands)Kept
Provision for income taxes Sourceyear ending December 31, 202638,000 to 44,000 (in thousands)Kept
Depreciation and amortization Sourceyear ending December 31, 202665,000 (in thousands)Kept
Stock-based compensation Sourceyear ending December 31, 202639,000 (in thousands)Kept
Income from equity method investments Sourceyear ending December 31, 2026(4,000) (in thousands)Kept
Other, net Sourceyear ending December 31, 20267,000 (in thousands)Kept

What changed from last quarter

  • New guidance: Guidance given for the three months ending June 30, 2026, after first-quarter guidance in the March release. Source
  • New guidance: Free cash flow range included for 2026; the March release did not include a free cash flow figure. Source
  • Guidance kept: Full-year 2026 total revenue and Adjusted EBITDA ranges reiterated on the existing business basis. Source
  • New: Delegated full-risk model launched with a payer partner in Texas. Source

Results and growth drivers

  • Revenue up 56% year over year: Total revenue was $965.1 million, against $620.4 million a year earlier, the company reported for the first quarter of 2026. Source
  • Adjusted EBITDA up 82%: Adjusted EBITDA was $66.3 million. The company defines the margin as Adjusted EBITDA over total revenue, and reported it at 7% against 6%. Source
  • Net income to Astrana up 116%: Net income attributable to Astrana was $14.4 million, and diluted EPS was $0.29 against $0.14. Net income before non-controlling interests was $13.1 million. Source
  • Operating income rose to $28.5 million: Income from operations was $28.5 million against $20.6 million a year earlier, with income from equity method investments of $1.7 million. Source
  • Adjusted EPS up 76%: Adjusted EPS - diluted was $0.74 against $0.42, computed on adjusted net income attributable to Astrana of $36.4 million. Source

Segment results

  • Care Partners revenue up 51%: Care Partners revenue was $909.7 million and income from operations was $39.5 million, down 11% from a year earlier. It is the largest segment by revenue. Source
  • Care Delivery posted an operating loss: Care Delivery revenue was $85.1 million, up 155%, and its loss from operations was $3.0 million. Source
  • Care Enablement income up 470%: Care Enablement revenue was $87.7 million, up 122%, with income from operations of $20.2 million. Sublease income between segments is shown in other income. Source
  • Eliminations and corporate costs: Intersegment eliminations reduced revenue by $117.4 million. Corporate costs were $28.1 million of total expenses. Source

“Combined with our longitudinal patient relationships and data continuity, our infrastructure allows us to translate AI into durable clinical and economic value”

Brandon Sim, President and Chief Executive Officer of Astrana Health

Revenue mix and membership

  • Capitation is the largest revenue line: Capitation, net was $892.9 million against $584.0 million. Management fee income rose to $15.7 million from $2.3 million. Source
  • Fee-for-service revenue more than doubled: Fee-for-service, net revenue was $37.8 million against $14.9 million, and other revenue was $6.2 million. Source
  • About 80% of capitation now full-risk: The company said about 80% of Care Partners capitation revenue and about 40% of consolidated membership are now in full-risk arrangements. Source
  • Provider and patient base: The company said it supports more than 20,000 providers and approximately 1.55 million patients in value-based care arrangements through its networks, MSO and clinics. Source

Costs, margins and medical costs

  • Cost of services rose with revenue: Cost of services, excluding depreciation and amortization, was $859.4 million against $549.1 million. Management referred to medical cost performance in its summary. Source
  • Medical liabilities rose: Medical liabilities were $439.3 million at March 31, 2026, against $335.7 million at December 31, 2025. Source
  • General and administrative costs up: General and administrative expenses were $61.7 million against $43.9 million. Depreciation and amortization was $15.5 million against $6.8 million. Source
  • Other, net includes integration and severance: Other, net of $10.7 million is a non-GAAP adjustment that includes post-acquisition integration costs and severance fees, as well as a receivables allowance. Source
  • Acquired intangible amortization rose: Amortization of intangibles from acquisitions was $13.9 million against $6.3 million, and is added back in adjusted EPS. Source

“We believe Astrana is well positioned to continue widening that advantage over time.”

Brandon Sim, President and Chief Executive Officer of Astrana Health

Cash flow and balance sheet

  • Operating cash flow rose to $68.1 million: Net cash provided by operating activities was $68.1 million against $16.6 million, with changes in operating assets and liabilities adding $26.5 million. Source
  • Net leverage fell to about 2.3x: Net leverage was about 2.3x on a pro forma trailing twelve-month basis and 2.2x on the midpoint of full-year guidance. The company said deleveraging is ahead of schedule. Source
  • Long-term debt balance: Long-term debt, net of current portion, was $979.8 million at March 31, 2026, against $990.9 million at December 31, 2025. The current portion was $47.9 million. Source
  • Interest expense rose: Interest expense was $16.1 million against $7.3 million a year earlier, with interest income of $3.8 million. Source
  • Cash balance rose: Cash and cash equivalents were $478.4 million at March 31, 2026, up from $429.5 million at December 31, 2025. Source

Returns to shareholders

  • Dividends and debt repayments: Dividends paid were $0.1 million against $5.5 million. Debt repayments were $12.0 million against $428.2 million in the prior-year quarter. Source
  • Treasury share buybacks of $2.9 million: The company repurchased $2.9 million of treasury shares in the quarter, against none in the prior-year quarter. Source
  • Repurchase authorization raised in March: In the prior release, the board raised the repurchase authorization to $100 million from $50 million.
  • Shares outstanding rose: Shares issued and outstanding were 48,946,399 at March 31, 2026, against 48,885,358 at December 31, 2025. Source

Strategy, platform and quality

  • Proprietary platform embeds AI: The CEO described a proprietary platform that places AI and workflow orchestration inside clinical and operational work across the enterprise. Source
  • Patient safety award recognition: Foothill Regional Medical Center received the Healthgrades 2026 Patient Safety Excellence Award for the fourth consecutive year. Source
  • Joint replacement award: Foothill Regional Medical Center also received the Healthgrades Joint Replacement Excellence Award for the second consecutive year. Source

Forward guidance

  • Free cash flow range added: The full-year free cash flow range is built from net cash provided by operating activities less purchases of property and equipment, each given as a range. Source
  • No quarterly EBITDA reconciliation: The company said it could not reconcile June-quarter EBITDA and Adjusted EBITDA to GAAP net income without unreasonable efforts, because some line items cannot be calculated. Source
  • First-quarter ranges given in March: The March release gave first-quarter revenue guidance of $900 million to $1,000 million and Adjusted EBITDA guidance of $60 million to $70 million.

Coming up, as management said on 7 May 2026

  • Slide deck and 8-K exhibit: A PDF slide presentation is to be posted on the IR calendar page and furnished as an exhibit to a Form 8-K. Source

Figures management reported

FigureReported
Providers supported Sourcemore than 20,000
Patients in value-based care arrangements Sourceapproximately 1.55 million
Medicare Advantage members in Texas market Sourcemore than 14,000
Consolidated membership in full-risk arrangements Sourceapproximately 40%
Care Partners capitation revenue in full-risk arrangements Sourceapproximately 80%

Risks management discussed

  • Financial: The company recorded an allowance on receivables it plans to recover from a payer, included in Other, net. Source
  • Operational: New full-risk contracts are early in their performance, which management said is in line with its expectations. Source

Earlier plans management reported on

  • Met: Management said it delivered on its commitment to convert key contracts to full-risk arrangements. Source
  • Ahead: Management said deleveraging continued ahead of schedule, with net leverage falling to about 2.3x. Source
  • On track: Management described early performance of new full-risk contracts as in line with its expectations. Source

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.