Executive Summary

Q1 2024 delivered strong operational scaling: revenue $404.4M (+20% YoY) and diluted EPS $0.31 (+11% YoY), with Adjusted EBITDA $42.2M (+42% YoY) and 10% Adjusted EBITDA margin, driven by membership growth to ~1.0M and deeper full‑risk arrangements .
Versus estimates, EPS beat by $0.01 while revenue missed by $9.49M per Seeking Alpha consensus; S&P Global consensus was unavailable via API at time of writing .
Guidance was reiterated: FY24 revenue $1.65–$1.85B, net income $61–$73M, Adjusted EBITDA $165–$185M, EPS diluted $1.28–$1.52 (unchanged from Q4 2023) .
Strategic catalysts: closed the second/final part of Community Family Care (CFC) acquisition (largest in company history), acquired PCCCV, and opened two de novo Nevada clinics; management expects ~60% of total capitation revenue to be in full‑risk as of April 1, 2024 .
Stock-relevant narrative: strong EPS execution and reiterated FY24 guide offset by revenue miss vs consensus and higher interest expense YoY, with mix shifting to full‑risk Medicaid and continued bolt‑on acquisitions .

What Went Well and What Went Wrong

What Went Well

“Revenue growth of 20%, net income attributable to Astrana growth of 13% and adjusted EBITDA growth of 42% … primarily driven by solid membership growth … and successful management of total cost of care” — Brandon K. Sim, CEO .
Membership scaled to approximately one million lives, with organic growth of ~10% YTD and ~60% of total capitation revenue expected in full‑risk arrangements as of April 1, 2024 .
Segment execution: Care Partners revenue up 26% YoY to $397.1M with income from operations up 94% YoY to $43.2M, reflecting leverage as risk mix increases .

What Went Wrong

Revenue missed consensus by $9.49M (EPS beat by $0.01); S&P Global consensus was unavailable via API, alternative consensus per Seeking Alpha .
Interest expense rose to $7.6M from $3.3M YoY, reflecting higher debt to fund growth and acquisitions; “Other (loss) income” swung to a $4.3M loss (vs +$1.2M YoY), and G&A increased to $38.7M from $21.2M YoY .
Care Delivery posted an operating loss of $(0.24)M, highlighting margin pressure as care sites ramp and integrate, while working capital declined to $183.5M from $242.8M QoQ .

Financial Results

Core P&L vs prior quarters and estimates

Metric	Q3 2023	Q4 2023	Q1 2024	YoY Q1	QoQ Q1	Versus Estimates
Revenue ($M)	$348.173	$353.036	$404.356	+20.0%	+14.6% (calc)	Miss by $9.49M
EPS – Diluted ($)	$0.47	$0.26	$0.31	+11%	+$0.05 (calc)	Beat by $0.01
Net Income attributable ($M)	$22.059	$12.356	$14.835	+13%	+$2.48 (calc)	N/A
Adjusted EBITDA ($M)	$51.974	$29.014	$42.245	+42%	+$13.23 (calc)	N/A
Adjusted EBITDA Margin (%)	15% (calc: 51.974/348.173)	8%	10%	+100 bps	+200 bps vs Q4	N/A

Note: S&P Global consensus was unavailable via API; consensus comparison reflects Seeking Alpha .

Revenue composition

Component ($M)	Q3 2023	Q4 2023	Q1 2024
Capitation, net	$305.678	$309.184	$365.910
Risk pool settlements & incentives	$15.022	$14.863	$17.377
Management fee income	$9.898	$6.390	$4.078
Fee-for-service, net	$15.892	$18.442	$15.937
Other revenue	$1.683	$4.157	$1.054
Total revenue	$348.173	$353.036	$404.356

Segment breakdown (revenue and operating income)

Segment	Q3 2023 Revenue ($M)	Q4 2023 Revenue ($M)	Q1 2024 Revenue ($M)	Q1 2024 Income from Operations ($M)
Care Partners	$326.5	$333.7	$397.1	$43.196
Care Delivery	$29.3	$38.5	$30.7	$(0.238)
Care Enablement	$36.9	$33.4	$33.3	$3.504
Intersegment Elimination/Other	$(44.8)	$(52.8)	$(56.732)	$0.772 (intersegment rental)
Consolidated Total	$348.2	$353.0	$404.4	$30.139

KPIs and balance sheet highlights

KPI	Q4 2023	Q1 2024
Members in value‑based care	~900k	~1.0M
% of total capitation revenue in full‑risk (expected)	N/A	~60% as of Apr 1, 2024
Cash & marketable securities ($M)	$296.31	$337.29
Working capital ($M)	$242.83	$183.54
Total stockholders’ equity ($M)	$616.65	$657.98
Interest expense ($M)	$5.422 (Q4)	$7.585 (Q1)

Guidance Changes

Metric	Period	Previous Guidance (Q4 2023)	Current Guidance (Q1 2024)	Change
Total Revenue ($B)	FY 2024	$1.65 – $1.85	$1.65 – $1.85	Maintained
Net Income attributable ($M)	FY 2024	$61 – $73	$61 – $73	Maintained
Adjusted EBITDA ($M)	FY 2024	$165 – $185	$165 – $185	Maintained
EPS – diluted ($)	FY 2024	$1.28 – $1.52	$1.28 – $1.52	Maintained

Earnings Call Themes & Trends

Topic	Previous Mentions (Q3 2023 and Q4 2023)	Current Period (Q1 2024)	Trend
Full‑risk transition	Announced intent to acquire CFC assets with RKK license (Medicaid full‑risk) and narrowed FY23 guidance . Rebranded to Astrana Health; reiterated FY24 guidance .	Expect ~60% of total capitation revenue in full‑risk as of Apr 1, 2024 .	Accelerating risk exposure (Medicaid and MA).
Acquisitions/Partnerships	CFC asset purchase and BASS partnership; Advantage Health Network clinics; Wider Circle ECM JV .	Closed second/final CFC part (largest deal) and acquired PCCCV; opened 2 Nevada clinics .	Ongoing bolt‑ons to scale membership and care delivery footprint.
Geographic expansion	Bay Area clinics added (Care Delivery) ; plan to enter new markets .	Two new de novo clinics in Nevada; started full‑risk delegated contract in Nevada .	New state expansion with payer contracts.
ACO/MSSP programs	Began MSSP ACO Enhanced Track Jan 1, 2024 .	Continued focus on value‑based contracts; risk pool incentives up YoY .	Stable, supportive of margin mix.
Financial profile and margins	Adj. EBITDA 8% in Q4; FY24 guide reiterated .	Q1 Adj. EBITDA margin 10% (+100bps YoY) .	Margins recovering sequentially from Q4.

Note: Q1 2024 earnings call was held May 7, 2024 at 5:30pm ET; supplemental deck available on IR site .

Management Commentary

“We believe our strong first quarter performance continues to demonstrate the uniqueness of our platform, care model, and technology… We also made further progress transitioning our members into full‑risk arrangements, which [we] expect to account for approximately 60% of our total capitation revenue as of April 1, 2024.” — Brandon K. Sim, President & CEO .
Strategic actions: “We successfully closed the second and final part of our Community Family Care acquisition… [and] completed the acquisition of Prime Community Care of Central Valley… We opened two new de novo clinics in Nevada in April.” .
Guidance stance: Astrana reiterated FY24 guidance ranges for revenue, net income, Adjusted EBITDA, and EPS diluted .

Q&A Highlights

Call logistics: May 7, 2024 at 5:30pm ET; replay and slides available on IR website/webcast .
Participants included analysts from William Blair, BTIG, Bank of America, Jefferies, Truist Securities, and TD Securities .
Street reaction context: EPS beat by $0.01; revenue miss by $9.49M (Seeking Alpha); management reiterated FY24 guidance .

Estimates Context

S&P Global consensus was unavailable via API at time of writing; alternative consensus and beat/miss magnitudes are shown from Seeking Alpha.

Metric	Actual (Q1 2024)	Consensus (Alt)	Beat/Miss	Source
Revenue ($M)	$404.356	$413.846 (derived: actual + $9.49M miss)	Miss by $9.49M	Seeking Alpha
EPS – Diluted ($)	$0.31	$0.30 (derived: actual − $0.01 beat)	Beat by $0.01	Seeking Alpha

Note: S&P Global consensus unavailable via API.

Key Takeaways for Investors

Membership scale and risk mix are inflecting: ~1.0M lives and ~60% of capitation revenue in full‑risk as of Apr 1, 2024, which should enhance visibility and unit economics in Care Partners .
Operating leverage evident: Care Partners operating income +94% YoY with segment revenue +26% YoY in Q1; focus on cost of care management continues to drive margins .
Sequential margin recovery from Q4: Adj. EBITDA margin improved to 10% in Q1 (vs 8% in Q4), with FY24 guide unchanged, suggesting confidence in delivery against plan .
Financing costs rising: Interest expense increased to $7.6M (from $3.3M YoY), consistent with balance sheet supporting acquisitions; monitor debt/interest trajectory relative to EBITDA growth .
Cash and equity strengthened QoQ: Cash & marketable securities rose to $337.3M; stockholders’ equity increased to $658.0M, providing capacity for continued M&A and clinic expansion .
Near‑term trading lens: Mixed tape—EPS beat vs revenue miss and higher interest expense—offset by reiterated FY24 guidance and accelerating full‑risk mix; acquisition integration milestones (CFC final close, PCCCV) remain key watch items .
Medium‑term thesis: Repeatable growth playbook (de novo clinics, payer contracts, MSO/IPAs) and technology‑enabled cost‑of‑care management underpin sustainable growth with targeted 10–15% Adj. EBITDA margins at scale .

Additional Primary Sources reviewed

Q1 2024 press release (8‑K Item 2.02, Exhibits 99.1 & 99.2) .
IR press release and webcast references (release scheduling and results) .
Prior quarters press releases for trend analysis (Q3 2023, Q4 2023 8‑Ks) .

Astrana Health, Inc. (AMEH)·Q1 2024 Earnings Summary