Business Overview and History
Astrana Health Inc (ASTH) is a leading provider-centric, technology-powered healthcare company that is transforming the way healthcare is delivered in the United States. With a focus on empowering providers to offer accessible, high-quality, and high-value care to all, Astrana has built an integrated platform that seamlessly connects payers, providers, and patients.
Astrana Health, Inc., formerly known as Apollo Medical Holdings, Inc., was founded in 1999 and is headquartered in Alhambra, California. The company started as a provider-centric, technology-powered healthcare management company, leveraging its proprietary population health management and healthcare delivery platform to operate an integrated, value-based healthcare model.
In 2015, Apollo Medical Holdings, Inc. purchased 1.11 million units, each consisting of one share of Series A Convertible Preferred Stock and a common stock warrant, from AHM, a subsidiary of the company. The following year, in 2016, the company purchased an additional 555.55 thousand units, each consisting of one share of Series B Convertible Preferred Stock and a common stock warrant, from AHM.
A significant milestone in the company's history occurred in 2017 when Apollo Medical Holdings, Inc. merged with Network Medical Management, Inc., and was renamed Astrana Health, Inc. As part of the merger, the company acquired Astrana Health Management, Inc. (formerly Network Medical Management, Inc.), which had entered into long-term management and/or administrative services agreements with numerous independent practice associations (IPAs) and medical groups.
Astrana's growth strategy has included various acquisitions over the years. In 2019, the company acquired Bright Health Company of California, Inc., further expanding its capabilities and market presence. More recently, in 2023, Astrana acquired certain assets from Prospect Medical Holdings, Inc., allowing the company to extend its provider network and healthcare services across California, Nevada, and Texas.
Today, Astrana operates three key business segments: Care Partners, Care Delivery, and Care Enablement. The Care Partners segment focuses on building and managing high-quality provider networks, the Care Delivery segment operates primary care, specialty care, and ancillary care clinics, and the Care Enablement segment provides a comprehensive technology platform to support value-based care. Astrana's business model centers on providing value-based care enablement services and care delivery through its consolidated care partners, serving patients primarily covered by private or public insurance, including Medicare, Medicaid, and commercial plans, as well as some self-pay patients.
Financial Performance and Outlook
Astrana has demonstrated strong financial performance in recent years, with revenue growing from $773.91 million in 2021 to $1.39 billion in 2023, representing a compound annual growth rate (CAGR) of 34.5%. During this period, the company's net income has also grown from $46.05 million to $60.72 million, a CAGR of 15.1%.
For the most recent fiscal year (2023), Astrana reported revenue of $1.39 billion, net income of $60.72 million, operating cash flow of $68.23 million, and free cash flow of $39.70 million. In the most recent quarter (Q3 2024), the company reported revenue of $478.71 million, a 37% increase year-over-year, while net income decreased by 27% to $16.09 million. Operating cash flow for the quarter was $33.98 million, with free cash flow of $31.69 million.
The increase in revenue was primarily driven by the company's recent acquisitions within its Care Partners segment, including the acquisition of CFC IPA assets that closed on January 31, 2024, and Restricted Knox-Keene licensed health plans acquired in 2024. This contributed to a 41% increase in capitation revenue. The decrease in net income was due to timing differences in the recognition of certain incentive dollars and ACO REACH performance.
One of the key drivers of Astrana's financial success has been its ability to successfully transition its business towards full-risk, value-based care arrangements. As of September 30, 2024, the company's full-risk business made up approximately 61% of its total capitation revenue, up from 46% a year earlier. Astrana is aiming to have around two-thirds of its capitation revenue coming from full-risk arrangements by January 1, 2025.
Looking ahead, Astrana has provided updated guidance for the full year 2024. The company now expects revenue to be in the range of $1.95 billion to $2.03 billion, up from the prior range of $1.75 billion to $1.85 billion. Adjusted EBITDA is expected to be between $165 million and $175 million, compared to the prior guidance of $165 million to $185 million. Earnings per diluted share are projected to be in the range of $1.06 to $1.19, compared to the prior guidance of $1.12 to $1.36.
The updated guidance incorporates the financial contribution from the acquisition of Collaborative Health Systems (CHS), which is expected to have a negative $4 million adjusted EBITDA impact in Q4 2024 but is projected to contribute $450 million in revenue and reach breakeven adjusted EBITDA by the end of 2025.
Acquisition of Prospect Health
In November 2024, Astrana announced a definitive agreement to acquire certain businesses and assets of Prospect Health, a provider of a range of healthcare services in several states. The $745 million transaction, which is expected to close in the middle of 2025, will further expand Astrana's geographic footprint and service offerings.
Prospect Health operates a licensed health care service plan, medical groups, a management service organization, and a pharmacy, among other assets. The acquisition is expected to be accretive to Astrana's financial performance, with the company anticipating around $450 million in revenue contribution from Prospect Health in 2025 and the business reaching breakeven adjusted EBITDA by the end of that year.
Business Segments
Astrana operates through three main business segments:
1. Care Partners Segment: This segment focuses on building and managing high-quality provider networks through partnerships with independent practice associations (IPAs), accountable care organizations (ACOs), and state-specific entities. For Q3 2024, the Care Partners segment reported revenue of $455.76 million, a 42% increase year-over-year, and operating income of $38.79 million, a 4% decrease year-over-year.
2. Care Delivery Segment: This segment includes primary care clinics, specialty care clinics, inpatient services, and ancillary service providers. In Q3 2024, the Care Delivery segment reported revenue of $34.73 million, a 20% increase year-over-year, and operating income of $1.36 million, a 31% increase year-over-year.
3. Care Enablement Segment: This segment provides a comprehensive technology platform to support value-based care delivery. For Q3 2024, the Care Enablement segment reported revenue of $40.93 million, an 11% increase year-over-year, and operating income of $6.31 million, a 2% decrease year-over-year.
Market Position and Industry Trends
Astrana primarily operates in the United States, with the majority of its revenue coming from California, Texas, and Nevada. The company has over 10,000 contracted physicians across its risk-bearing organizations and is responsible for coordinating care for approximately 1 million patients.
The managed care industry has seen steady growth, with a CAGR of around 6-8% over the past 5 years. Astrana has outperformed the industry average, growing revenue at a 15-20% CAGR over the same time period.
Financial Health and Liquidity
As of Q3 2024, Astrana reported a debt-to-equity ratio of 0.37 and cash and cash equivalents of $347.99 million. The company has a $400 million revolving credit facility, of which $146.73 million was drawn as of Q3 2024. Astrana's current ratio and quick ratio both stand at 1.91, indicating a strong ability to meet short-term obligations.
Risks and Challenges
While Astrana has demonstrated impressive growth and financial performance, the company faces several risks and challenges that investors should be aware of.
One key risk is the company's heavy reliance on value-based care arrangements, which can expose it to potential downside risk if medical costs exceed projections. Astrana has, however, shown its ability to manage medical costs effectively, with blended cost trends across its lines of business evolving in the mid-single-digit percentage range.
Another risk is the highly competitive nature of the healthcare industry, with the company facing competition from both traditional healthcare providers and emerging technology-focused players. Astrana's ability to continually innovate and enhance its technology platform will be crucial in maintaining its competitive edge.
Additionally, the company's growth strategy, which includes both organic expansion and strategic acquisitions, carries integration risks that must be managed carefully. The successful integration of Prospect Health will be a key focus for Astrana in the coming years.
Conclusion
Astrana Health Inc (ASTH) has established itself as a leading provider-centric, technology-powered healthcare company, with a comprehensive platform that is transforming the way healthcare is delivered in the United States. The company's strategic focus on value-based care, coupled with its innovative technology solutions and disciplined execution, have driven impressive financial performance and positioned it for continued growth.
As Astrana looks to the future, the company's ability to successfully navigate the evolving healthcare landscape, manage risks, and execute on its acquisition strategy will be crucial in determining its long-term success. With a strong market position, a highly capable management team, and a clear vision for the future, Astrana appears well-positioned to continue playing a pivotal role in shaping the future of healthcare delivery.