Astrana Health (ASTH) Q1 2026 earnings summary

Executive summary

• Q1 2026 revenue reached $965.1 million, up 56% year-over-year, with adjusted EBITDA of $66.3 million, up 82% year-over-year, and net income attributable to shareholders of $14.4 million, a 116% increase.

• Adjusted EPS-diluted was $0.74, up 76% year-over-year; EPS-diluted was $0.29, up 107%.

• Free cash flow for Q1 2026 was $64.1 million, up 372% year-over-year.

• Disciplined growth, operating leverage, and AI-enabled efficiencies drove margin gains and strong clinical and medical cost performance.

• Membership in value-based arrangements grew to 1.55 million, with 80% of Q1 2026 revenue from full-risk contracts.

Financial highlights

• Capitation revenue was $892.9 million, up from $584.0 million in Q1 2025; Care Partners revenue was $909.7 million, up 51% year-over-year.

• Adjusted EBITDA margin improved to 7% from 6% year-over-year.

• Cash and cash equivalents at quarter-end were $478.4 million; net debt was $586.8 million.

• Net leverage declined to 2.3x on a pro forma trailing twelve-month basis.

• Net cash provided by operating activities was $68.1 million, up 309% year-over-year.

Outlook and guidance

• Full-year 2026 revenue guidance: $3.8–$4.1 billion; adjusted EBITDA: $250–$280 million; free cash flow: $105–$132.5 million.

• Q2 2026 guidance: revenue $965–$1,000 million; adjusted EBITDA $65–$70 million.

• Guidance assumes conservative Medicaid trends, zero HQAF contribution, and ~81% of 2026 revenue from full-risk arrangements.

• 2027 EBITDA target of $350 million remains achievable, with mid-to-high teens organic growth expected.

• Management expects continued benefit from stable Medicare Advantage rates and risk adjustment policies for 2027.