Astrana Health Posts Record ACO Savings as Revenue Growth Holds at 56%
Astrana Health's affiliated accountable care organizations generated $120.4 million in gross shared savings for the 2024 performance year, with all eight ACOs turning a net profit for the first time.
Astrana Health (ASTH) network of accountable care organizations generated $120.4 million in gross shared savings for the 2024 performance year, with all eight affiliated ACOs, five under the Medicare Shared Savings Program and three under ACO REACH, posting net shared savings for the first time disclosed at this level of detail. The disclosure, issued July 13, is a shared-savings announcement rather than a standard quarterly report, a format not used in any of the company's four prior quarterly releases.
The value-based care company paired the ACO update with first-quarter 2026 results that showed its growth rate holding rather than slowing. Revenue rose 56% year over year to $965.1 million from $620.4 million, matching the 56% growth Astrana posted for full-year 2025, when revenue climbed to $3,181.8 million from $2,034.5 million. That marked an acceleration from the fourth quarter of 2025, when revenue grew 43% year over year to $950.5 million.
Profitability outpaced the top line. Adjusted EBITDA reached $66.3 million in the first quarter, up 82% from $36.4 million a year earlier, pushing the adjusted EBITDA margin to 7% from 6%. Free cash flow jumped 372% to $64.1 million from $13.6 million, the sharpest swing among the metrics Astrana disclosed. Net income attributable to Astrana rose 116% to $14.4 million from $6.7 million, though that followed a full year in which 2025 net income of $22.5 million fell roughly 48% from $43.1 million in 2024 even as revenue grew 56%. Interest expense nearly doubled to $16.1 million from $7.3 million, a drag that has grown faster than revenue and weighed on net income relative to operating income.
The quarterly margin gains came alongside full-year compression: 2025 adjusted EBITDA margin fell to 6% from 8% in 2024, even as the fourth quarter and first quarter each showed improvement over their year-earlier periods. The company's shift toward full-risk contracts helps explain both the margin recovery and the segment mix moving underneath it. Full-risk capitation revenue rose to roughly 80% of Care Partners' capitation mix by the first quarter, up from 64% for all of 2025, and full-risk membership reached about 40% of the consolidated base, up from 20% in 2025 — a faster jump than the multi-year progression from 35% in 2021 to 76% in 2024.
Segment results diverged sharply. Care Partners operating income fell 11% year over year even as segment revenue grew 51%, pointing to margin pressure inside the core risk-bearing business. Care Enablement, by contrast, grew operating income 470% on 122% revenue growth, and Care Delivery posted an operating loss of $2.96 million, a 5% year-over-year decline that extends a losing streak across recent quarters, including a $2.0 million full-year 2025 operating loss.
Astrana guided second-quarter revenue of $965 million to $1,000 million and reiterated full-year 2026 guidance of $3,800 million to $4,100 million in revenue and $250 million to $280 million in adjusted EBITDA, both unchanged from the range issued with fourth-quarter results. The company's full-year 2025 revenue of $3,181.8 million and adjusted EBITDA of $205.4 million came in at or above the $3,100 million to $3,180 million revenue and $200 million to $210 million EBITDA range it had reiterated as of the third-quarter 2025 release.
Astrana's board raised its share repurchase authorization to $100 million from $50 million in the fourth-quarter release, alongside disclosure of a material weakness in internal control over financial reporting tied to acquisition accounting that required a Form 12b-25 filing extension. Neither item appeared in the ACO or first-quarter releases. The company also continued deleveraging, with pro forma net debt to adjusted EBITDA falling to about 2.3x on a trailing-twelve-month basis by the first quarter from roughly 2.5x as of the third quarter of 2025, and a guided 2.2x at the midpoint of full-year targets.