Executive Summary

Q1 2025 revenue grew 53% year over year to $620.4M; Adjusted EBITDA was $36.4M with a 6% margin, near the top of the prior Q1 guidance range of $32–$37M and within the $600–$650M revenue guide .
Versus S&P Global consensus, revenue modestly missed ($620.4M vs $630.7M*), while S&P “Primary EPS” beat ($0.342* vs $0.207*). Note: S&P “Primary EPS” is a normalized measure that is not directly comparable to GAAP diluted EPS ($0.14) reported by the company .
Management reiterated FY 2025 guidance (Revenue: $2.5–$2.7B; Adj. EBITDA: $170–$190M) and introduced Q2 2025 guidance (Revenue: $615–$655M; Adj. EBITDA: $45–$50M). Guidance includes ~$15M of integration/AI investments and excludes unclosed M&A contributions .
Strategic execution: CHS integration is complete with >$10M identified G&A efficiencies; full‑risk continues to mix up (75% of capitation revenue; 38% of members), and the team remains on track to close Prospect in summer with expected ~$81M adjusted EBITDA and $12–$15M synergies .

Values with asterisk (*) in this report are retrieved from S&P Global.

What Went Well and What Went Wrong

What Went Well

Revenue +53% YoY to $620.4M, driven by Care Partners +57% YoY; Q1 Adj. EBITDA of $36.4M landed near top of prior company guidance for the quarter .
CHS integration complete; management identified and executed on >$10M of G&A efficiencies, with CHS on track to break even in 2025 and profitability in 2026 .
Risk progression continues: 75% of capitation revenue now from full‑risk and 38% of members in full‑risk contracts; management notes mid‑single‑digit blended utilization trend, on plan .

What Went Wrong

Profitability compression: GAAP diluted EPS fell to $0.14 (vs $0.31 YoY); Adjusted EBITDA margin declined to 6% (from 10% YoY) on planned integration/tech investments and near‑term mix to lower‑margin cohorts (CHS, newly converted full‑risk) .
Medicaid trend ran above blended trend (flu‑driven ER/lab utilization), weighing on margins; management is not assuming Medicaid rate relief in 2025 guidance .
S&P Global shows a revenue miss versus consensus in Q1; the S&P “Primary EPS” beat is not directly comparable to company GAAP EPS, adding complexity for headline comparisons .

Financial Results

Headline P&L and Margins

Metric	Q1 2024	Q4 2024	Q1 2025
Revenue ($M)	404.4	665.2	620.4
Net income attributable to Astrana ($M)	14.8	(7.0)	6.7
GAAP Diluted EPS ($)	0.31	(0.15)	0.14
Income from operations ($M)	30.1	0.7	20.6
Adjusted EBITDA ($M)	42.2	35.0	36.4
Adjusted EBITDA margin (%)	10%	5%	6%

Versus S&P Global Consensus (Q1 2025)

Metric	Consensus*	Reported
Revenue ($M)	630.7*	620.4
Primary EPS (S&P) ($)	0.207*	0.342*

Notes: S&P “Primary EPS” is a normalized/adjusted measure and not directly comparable to company GAAP diluted EPS of $0.14 in Q1 2025 . Values with asterisk (*) retrieved from S&P Global.

Segment Revenue

Segment ($M)	Q4 2024	Q1 2025
Care Partners	647.7	601.0
Care Delivery	36.4	33.4
Care Enablement	45.1	39.6
Intercompany	(63.9)	(53.5)
Total Revenue	665.2	620.4

KPIs and Mix (Q1 2025)

KPI	Q1 2025
Care Partners members (approx.)	910K
Capitation revenue from full‑risk	75%
Members in full‑risk	38%
Revenue by type	94% capitation; 2% risk pool; 1% management fee; 2% FFS; 1% other
Payer mix	63% Medicare; 28% Medicaid; 7% Commercial; 2% Other
CHS revenue contribution (Q1)	~$95M

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Total Revenue ($M)	Q2 2025	—	615–655	New
Adjusted EBITDA ($M)	Q2 2025	—	45–50	New
Total Revenue ($B)	FY 2025	2.5–2.7	2.5–2.7	Maintained
Adjusted EBITDA ($M)	FY 2025	170–190	170–190	Maintained

Assumptions: FY 2025 guidance includes ≈$15M of integration/automation/AI costs; excludes contributions from acquisitions not yet closed .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q3 2024 & Q4 2024)	Current Period (Q1 2025)	Trend
Utilization trend	FY 2024 blended utilization 5.3%; low single digit Medicare, mid single digit Commercial, high single digit Medicaid	Mid‑single‑digit blended in Q1; Medicaid above blended due to flu ER/lab; on track for full‑year	Stable vs plan
Risk progression	FY 2024: 73% of cap rev full‑risk; 33% members full‑risk	75% of cap rev full‑risk; 38% members full‑risk	Increasing
CHS integration	Close 10/4/24; integration substantially complete by Q2’25; breakeven late 2025, profitability in 2026	Integration complete; >$10M G&A efficiencies; on track to breakeven 2025, profitable 2026	Progressing
Prospect acquisition	Audited FY’24: ~$1.2B revenue; $94M adj. EBITDA; pro forma net leverage ~3.4x at close	HSR cleared; still awaiting CA approvals; expect ~$81M adj. EBITDA; $12–$15M synergies; summer close target	On track
AI/data enablement	~$15M 2025 investments; expect ≥$10M annual efficiencies by early 2026	Hired Chief Data & Analytics Officer; reaffirmed ~$10M 2026 efficiencies	Building
Regulatory (Prop 35, V28, Part D)	FY25 guide excludes Medicaid relief; caution on Medicaid trends	Prop 35 expected net neutral to EBITDA; no V28 headwind observed; <2% Part D exposure	Manageable

Management Commentary

“Adjusted EBITDA in the first quarter reflected our continued success in growing membership and value-based arrangements while managing cost trend effectively. Margins were moderated by planned ongoing investments in growth, integration, and technology, as well as by revenue growth in areas with lower near-term margin profiles, such as the CHS acquisition and newly converted full-risk members” .
“Integration [of CHS] is now complete… we’ve identified opportunities over $10 million worth of G&A efficiencies” .
“Approximately 38% of our members are now in full-risk contracts… those members now account for 75% of our capitated revenue” .
“We remain highly confident [in Prospect]… expect [it] to contribute around $81 million in adjusted EBITDA and deliver $12–$15 million in synergies” .
“With regards to V28, we have not seen a negative impact… exposure to Part D risk remains de minimis, with less than 2% of our members with any exposure” .

Q&A Highlights

Cadence and guidance: Back‑half weighted profitability driven by seasonality, maturation of full‑risk cohorts, CHS improvement; Q2 revenue guide reflects timing mix and seasonal factors; FY 2025 reiterated .
Medicaid trend/Prop 35/CA MCO tax: Q1 Medicaid elevated due to flu ER/lab; management not baking in Medicaid rate relief; Prop 35 expected net neutral to EBITDA; prepared to absorb variability if needed .
CHS trajectory: Integration complete, >$10M G&A efficiencies; breakeven in 2025, profitability in 2026; longer‑term margins to converge toward enterprise levels by line of business .
Prospect readiness and leverage: HSR cleared; data/tech scaling ahead of close; pro forma net leverage ~3.4x at close with plan to delever <3x within ~12 months .
ACO programs: Retro trend adjustment absorbed and offset by stop‑loss/other puts and takes; slight drag on revenue recognized .

Estimates Context

S&P Global Q1 2025 consensus vs reported: revenue $630.7M* vs $620.4M (miss), S&P Primary EPS $0.207* vs $0.342* (beat). Company-reported GAAP diluted EPS was $0.14 (not directly comparable to S&P Primary EPS) .
Implications: Modest top‑line shortfall against consensus, but S&P normalized EPS suggests underlying earnings ahead of Street’s adjusted expectations. Estimate revisions may bias neutral on revenue and slightly positive on normalized EPS; watch how models reconcile to GAAP EPS and Adjusted EBITDA.

Values with asterisk (*) retrieved from S&P Global.

Key Takeaways for Investors

Execution remains solid: +53% YoY revenue with disciplined cost control amid elevated Medicaid utilization; near‑term margin pressure is by design (integration/tech, CHS, early full‑risk) and should ease as cohorts mature .
Guidance credible and unchanged for FY 2025; Q2 guide sets achievable near‑term hurdles while management invests for 2026+ operating leverage (AI savings ≥$10M expected in 2026) .
Strategic catalysts: Prospect close (summer) with ~$81M adjusted EBITDA and $12–$15M synergies; continued full‑risk progression and regional scaling (NV at breakeven; TX profitability targeted late 2025) .
Regulatory risk manageable: No V28 impact observed; Prop 35 expected EBITDA‑neutral; minimal Part D risk (<2% membership) .
Watch list: Medicaid trend trajectory and any rate relief flow‑through; CHS breakeven and margin inflection; cadence of full‑risk conversions; timing of Prospect approvals/close .
Trading setup: Stock’s narrative likely keyed to execution on CHS profitability, clarity on Medicaid rates, and tangible milestones toward Prospect close/synergies—each could drive estimate and multiple support near term .

Appendix: Additional Context from Prior Quarters

Q4 2024 results: Revenue $665.2M; Adjusted EBITDA $35.0M; FY 2025 initial guidance $2.5–$2.7B revenue and $170–$190M Adj. EBITDA (unchanged in Q1) .
Q3 2024 results: Revenue $478.7M; Adjusted EBITDA $45.2M; raised FY 2024 revenue guidance at that time .