Astrana Health, Inc.

Second-quarter revenue was $973 million, up 49% year over year, with adjusted EBITDA of $69 million, up 43% year over year, and adjusted diluted EPS of $0.80, up 45% year over year. Net income attributable to Astrana was $20 million. Free cash flow totaled $93 million in the first half of 2026, and the company ended the quarter with $401 million in cash, $579 million of net debt, and pro forma net leverage of 2.26x trailing twelve months. For the full year, management raised adjusted EBITDA guidance to $255 million-$280 million, reaffirmed revenue guidance of $3.8 billion-$4.1 billion, reaffirmed free cash flow guidance of $105 million-$132.5 million, and guided third-quarter revenue to $1.0 billion-$1.03 billion and adjusted EBITDA to $72.5 million-$77.5 million. Management also said G&A should exit the year at approximately 6% of revenue.

Brandon Sim framed the quarter as evidence that Astrana’s “AI-native healthcare operating system” is scaling and creating operating leverage across clinical, operational, and administrative functions. He emphasized responsible growth, saying the company is using stronger-than-expected performance and cash flow to add more high-return opportunities while still maintaining underwriting discipline. He also highlighted the Prospect integration, saying the first year has validated the model and that the company is improving portfolio quality by shifting more business toward full-risk arrangements where economics align better.

Chan Basho said Q2 revenue of $973 million and adjusted EBITDA of $69 million were near the high end of guidance, helped by controlled trend, full-risk performance, Prospect synergies, and cost discipline. He noted a one-time $15 million revenue reduction tied to CMS’s ACO REACH adjustments for 2025 billing activity, but said the net impact to EBITDA was immaterial. He also highlighted strong liquidity and balance-sheet progress: $93 million of free cash flow in the first half, $92 million of debt retired, $401 million of cash, and pro forma gross leverage of 3.8x after the paydown. Guidance was raised even as the company plans to reinvest in growth, while full-year revenue and free cash flow guidance were reaffirmed.

Analysts pressed on medical cost trend, especially why commercial ran above expectations; management said overall trend was slightly better than the 5.2% assumption, commercial was only slightly high, and it did not warrant a guidance change. Questions also focused on membership shifts and 2027 visibility: management said Medicaid attrition is running toward the high end of expectations, exchange attrition is a bit better than the 30%-40% assumption but still guided conservatively, and Medicare membership is stable. On capital deployment and efficiency, management said G&A improvements are coming from both Prospect synergies and core operating changes, with no major distinction between the two. Analysts also asked about Texas, Hawaii, and Medi-Cal; management said Texas new lives are being added first in partial/“delegated” risk with a path to full risk, and California Medi-Cal members are being rebalanced toward full risk over the next 12 months, with “tens of thousands” of members potentially moving.