Astrana Health (ASTH) Q1 2026 earnings summary

Executive summary

• Q1 2026 revenue reached $965.1 million, up 56% year-over-year, with adjusted EBITDA up 82% to $66.3 million and net income attributable to shareholders up 116% to $14.4 million, driven by the Prospect acquisition, organic growth, and disciplined operating leverage.

• 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, a 372% increase year-over-year.

• Membership in value-based arrangements grew to 1.55 million, with 80% of Q1 2026 revenue from full-risk contracts and 40% of consolidated membership in full-risk arrangements.

• AI-enabled platform and operational efficiencies contributed to provider performance and patient engagement.

Financial highlights

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

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

• Free cash flow for the quarter was $64.1 million, up from $13.6 million a year ago; cash and cash equivalents at quarter-end were $478.4 million.

• Net leverage declined to 2.3x, ahead of the deleveraging schedule.

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

Outlook and guidance

• Full-year 2026 guidance reaffirmed: revenue $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 and zero HQAF contribution.

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

• Expect ~81% of 2026 revenue from full-risk arrangements.