Astrana Health (ASTH) Q4 2025 earnings summary

Executive summary

• Achieved record annual revenue of $3.18B, up 56% year-over-year, and record adjusted EBITDA of $205.4M, demonstrating consistent performance amid regulatory and market volatility.

• Expanded value-based care membership to 1.6 million, with disciplined growth and high provider retention, especially in core and expansion markets.

• Integration of Prospect Health is ahead of schedule, with over 97% provider retention and expected annualized synergies at the high end of the $12M–$15M range.

• Technology and AI-driven platform enabled operating leverage, improved clinical outcomes, and margin expansion.

• Free cash flow for the year was $104.5M, more than doubling from $44.2M in 2024.

Financial highlights

• Q4 2025 revenue was $950.5M, up 43% year-over-year; adjusted EBITDA was $52.5M, up 50%.

• Full year 2025 revenue reached $3.18B, adjusted EBITDA $205.4M, free cash flow $104.5M, and adjusted EPS $2.20.

• Net income for Q4 was $6M, EPS $0.12; full year net income attributable to shareholders was $22.5M, diluted EPS $0.46.

• Cash and cash equivalents at year-end were $429.5M, net debt $648.7M, and net leverage ratio 2.6x.

• Care Partners segment revenue grew 38% YoY in Q4 to $892.5M; full year revenue rose 55% to $3.02B.

Outlook and guidance

• 2026 revenue guidance: $3.8B–$4.1B; adjusted EBITDA: $250M–$280M; free cash flow: $105M–$132.5M.

• Q1 2026 revenue guidance: $900M–$1B; adjusted EBITDA: $60M–$70M.

• Guidance reflects expected 24% revenue growth and 29% adjusted EBITDA growth at the midpoint.

• Guidance incorporates conservative assumptions for Medicaid/exchange disenrollment, adverse selection, and zero HQAF contribution, offset by Medicare Advantage rate improvements, Prospect synergies, and AI-driven efficiencies.

• No M&A included in 2026 guidance; Q3 expected to be seasonally strongest.