Executive Summary

Revenue grew 100% year over year to $956.0M, at the high end of Q3 guidance and modestly above Wall Street consensus; Adjusted EBITDA was $68.5M, also at the high end of guidance .
GAAP diluted EPS was $0.01; management reiterated that cost trends remained within expectations, with guidance trimmed for FY25 solely due to timing of full‑risk contract transitions into Q1 2026 .
FY25 guidance was lowered to revenue $3.10–$3.18B and Adjusted EBITDA $200–$210M (from $3.10–$3.30B and $215–$225M), citing delays unrelated to core performance; Prospect Health’s standalone Q3 performance exceeded expectations, and $12–$15M synergy targets were reaffirmed .
Strategic catalysts: integration of Prospect (visibility, scale, leverage), Intermountain Health partnership in Nevada, and a new SoCal enablement client (~40K lives) onboarding in H1’26 .

What Went Well and What Went Wrong

What Went Well

“Astrana delivered solid third quarter results…strong momentum in our first quarter of combined operations with Prospect Health,” with Prospect exceeding expectations and integration progressing well .
Cost trends “remained firmly within expectations,” with Medicare trending favorably; blended legacy Astrana trend ~4.5% YoY and Medicaid sequentially improved vs Q2 .
Synergy plan reiterated: “We are reiterating our synergy targets of $12 to $15 million over the coming quarters” as enablement and platform standardization advance .

What Went Wrong

EPS compressed to $0.01 diluted despite strong top line; Adjusted EBITDA margin was 7% vs 9% in the prior year quarter, reflecting higher “Other, net” items (e.g., $13.0M legal matter, ~$12.7M transaction/integration costs) .
FY25 guidance cut (revenue and Adjusted EBITDA) due to delays in transitioning several contracts from partial‑ to full‑risk to Q1 2026, reducing expected FY25 contribution (timing, not fundamentals) .
Care Partners margin lagged Enablement in Q3; management noted Prospect’s trend runs “several points higher” than legacy Astrana, with opportunity to normalize post-integration .

Financial Results

Quarterly Financials vs Estimates

Metric	Q1 2025	Q2 2025	Q3 2025
Revenue ($USD Millions)	$620.4	$654.8	$956.0
Revenue Consensus Mean ($USD Millions)*	$630.7*	$638.3*	$952.8*
Variance vs Consensus ($USD Millions)*	-$10.3*	+$16.5*	+$3.2*
EPS (GAAP diluted) ($USD)	$0.14	$0.19	$0.01
Primary EPS Consensus Mean ($USD)*	$0.2072*	$0.3480*	$0.4413*
Variance vs Consensus ($USD)*	-$0.0672*	-$0.1580*	-$0.4313*
EBITDA ($USD Millions)	$21.449	$28.775	$35.462
EBITDA Consensus Mean ($USD Millions)*	$35.704*	$47.201*	$67.289*
Variance vs Consensus ($USD Millions)*	-$14.255*	-$18.426*	-$31.827*
Adjusted EBITDA ($USD Millions)	$36.386	$48.101	$68.482

Note: EPS consensus (“Primary EPS”) and EBITDA consensus reflect S&P Global methodologies and may not be directly comparable to GAAP diluted EPS or company-reported Adjusted EBITDA.
*Values retrieved from S&P Global.

Segment Breakdown (Q3 2025)

Segment ($USD Thousands)	Revenue	Cost of Services	G&A	D&A	Total Expenses	Income (Loss) from Operations
Care Partners	$897,730	$788,427	$72,066	$11,953	$872,446	$25,284
Care Delivery	$86,871	$72,210	$14,346	$1,332	$87,888	$(1,017)
Care Enablement	$87,340	$44,067	$17,756	$2,115	$63,938	$23,402
Intersegment Elimination	$(115,893)	$(45,848)	$(69,964)	—	$(115,812)	$(81)
Corporate Costs	—	—	$28,183	$195	$28,378	$(28,378)
Consolidated Total	$956,048	$858,856	$62,387	$15,595	$936,838	$19,210

KPIs

KPI	Q1 2025	Q3 2025
% Capitation Revenue from Full‑Risk	75%	77%
Revenue by Type	Capitation 94%; Risk/Incentives 2%; Mgmt Fees 1%; FFS 2%; Other 1%	Capitation 90%; Risk/Incentives 3%; Mgmt Fees 2%; FFS 4%; Other 1%
Revenue by Payer	Medicare 63%; Medicaid 28%; Commercial 7%; Other 2%	Medicare 60%; Medicaid 25%; Commercial 9%; Other 6%
Care Partners Membership	910K	~1.4M

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Revenue ($USD Billions)	FY 2025	$3.10–$3.30B	$3.10–$3.18B	Lowered
Adjusted EBITDA ($USD Millions)	FY 2025	$215–$225M	$200–$210M	Lowered
Q3 Revenue ($USD Millions)	Q3 2025	$925–$965	Actual $956.0	Delivered near high end
Q3 Adjusted EBITDA ($USD Millions)	Q3 2025	$65–$70	Actual $68.5	Delivered near high end
Synergies (Prospect)	12–18 months	$12–$15M	$12–$15M	Maintained

Management attributed FY25 guidance cuts to timing delays in full‑risk transitions, with completion expected in Q1 2026; underlying cost trends and performance remained stable .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q1 & Q2)	Current Period (Q3)	Trend
AI/Technology Initiatives	Investment expected to yield ≥$10M annual OpEx efficiencies by early 2026; platform integration of CHS	Expanded AI use in risk identification, claims analytics, LLM-enabled clinician queries; accelerating Prospect onboarding to Astrana platform by mid‑2026	Strengthening
Risk Progression (Full‑Risk)	75% of capitation revenue full‑risk; 38% Care Partners members full‑risk	77% revenue full‑risk; contract transitions delayed to Q1’26, not performance‑related	Mixed (higher mix; timing delay)
Medical Cost Trends	“Within expectations across all lines of business”	Legacy Astrana ~4.5% blended; Medicare favorable; Medicaid decelerated vs Q2; Prospect stable and slightly ahead of expectations	Stable/Improving
Partnerships/Growth	Q1: CHS integration; Q2: Prospect closed 7/1	Intermountain Health partnership in Nevada; new SoCal enablement client (~40K lives)	Expanding
Regulatory/Macro (Medicaid, MA rates)	—	Medicaid disenrollment manageable mid‑ to high‑single‑digit annualized YTD; expecting stabilization by late ’26; MA rate tailwinds into ’26/’27, limited V28 headwind	Watch (near‑term headwinds; medium‑term tailwinds)
Balance Sheet/Leverage	—	Cash ~$462M; net leverage ~2.5x on PF TTM Adjusted EBITDA; plan to delever via EBITDA growth and FCF	Improving

Management Commentary

“Prospect’s performance exceeded our expectations, and integration is progressing well…expanding our scale, capabilities, and physician reach across key markets.” — Brandon Sim, CEO .
“We are reiterating our synergy targets of $12 to $15 million over the coming quarters…standardizing operating systems and implementing the Astrana technology platform.” — Management .
“We now expect several payer contracts to transition…in the first quarter of 2026 instead of mid‑2025…this is purely a matter of timing.” — CEO .
“Medical cost trend…was stable and in line with our expectations across both legacy Astrana and Prospect.” — CFO .

Q&A Highlights

Guidance timing: FY25 reductions driven by delays across several payers and both legacy Astrana and Prospect; half procedural/regulatory filings, half operational feeds; clear sightline to Q1’26 go‑live .
Segment margins: Enablement margins strong on scale from Prospect clients; Care Partners margins lower given Prospect’s higher trend, with opportunity to normalize as integration progresses .
Medicaid/exchange exposure: Medicaid disenrollment manageable (mid‑ to high‑single digits annualized); exchange exposure ~3% of revenue; cautious stance into ’26 .
MA rates: Expect margin stabilization/expansion in ’26/’27 with strong rate notices; minimal impact from V28; opportunity from matured full‑risk cohorts and synergies .
Leverage/FCF: Net leverage ~2.5x PF; expect deleveraging via EBITDA growth and ~40–45% FCF conversion for FY25 .

Estimates Context

Revenue modestly beat consensus in Q3: $956.0M actual vs $952.8M consensus*; Q2 beat and Q1 slight miss vs consensus* .
EPS: Company reported GAAP diluted $0.01 vs S&P “Primary EPS” consensus $0.4413*; management did not provide non‑GAAP EPS, and S&P Primary EPS may differ from GAAP diluted .
EBITDA: Company reported EBITDA $35.462M and Adjusted EBITDA $68.482M; S&P EBITDA consensus was $67.289M*, indicating definitional differences; Adjusted EBITDA landed at the high end of company guidance .
Target price consensus mean: $42.38 from 8 estimates*; recommendation text unavailable via S&P pull.
*Values retrieved from S&P Global.

Key Takeaways for Investors

Integration execution strength: Prospect standalone performance ahead of plan, synergy target ($12–$15M) intact, and enablement margins robust—supportive of medium‑term margin trajectory .
Revenue quality vs EPS optics: Strong top line and Adjusted EBITDA at guidance high end, but GAAP EPS compressed by non‑core items (“Other, net”), highlighting the relevance of Adjusted EBITDA to underlying performance .
FY25 de‑risked by transparent timing: Guidance cut reflects delayed risk transitions, not operating deterioration; visibility to Q1’26 activation lowers execution risk and sets up FY26 acceleration .
Cost trend discipline sustained: Medicare favorable, Medicaid improving sequentially; management expects Medicaid stabilization by late ’26, with MA rate tailwinds into ’27 .
Balance sheet capacity: ~$462M cash, ~2.5x net leverage PF—room to invest while deleveraging via EBITDA growth and FCF conversion .
Strategic partnerships as growth vectors: Intermountain Health in Nevada and new SoCal enablement client (~40K lives) should augment scale and platform leverage without immediate risk assumption .
Near‑term trading lens: Focus on Q4 trend integrity and any early signals on Q1’26 full‑risk commencements; medium‑term thesis hinges on margin normalization at Prospect, enablement scale, and MA rate tailwinds .

Astrana Health, Inc. (ASTH)·Q3 2025 Earnings Summary