Astrana Health Q2 2026 earnings: Revenue rises 49% as diluted EPS more than doubles

Astrana Health (NASDAQ: ASTH) reported Q2 2026 revenue of $972.5 million, up 49% from $654.8 million, while diluted GAAP EPS rose 111% to $0.40 from $0.19. Net income attributable to Astrana increased 109% to $19.7 million, and adjusted EBITDA climbed 43% to $68.9 million, although the adjusted EBITDA margin remained at 7%.

The quarter featured rapid revenue growth across all three operating segments. However, Care Partners operating income declined despite substantially higher revenue, making segment profitability an important issue to monitor.

Core earnings results

Capitation revenue provided most of the top-line expansion, increasing to $905.8 million from $614.1 million. Total operating expenses rose 48% to $938.2 million, slightly slower than revenue, allowing operating income to increase 69% to $34.3 million.

General and administrative expenses grew only 7% to $54.2 million, but cost of services increased 51% to $868.5 million and depreciation and amortization more than doubled to $15.6 million.

Adjusted results exclude items including stock-based compensation, acquisition-related intangible amortization, integration costs, certain legal accruals, severance, and tax adjustments.

Business and segment performance

All three operating segments generated substantial revenue growth, but their profit trends diverged. Segment revenue includes intersegment activity; Astrana recorded $120.6 million of intersegment revenue eliminations in arriving at consolidated revenue.

Care Partners remained the company’s largest business by a wide margin. Care Enablement delivered the fastest revenue growth and contributed $16.4 million of operating income, while Care Delivery reported an operating loss despite nearly doubling revenue.

Within consolidated revenue, management fee income increased to $13.2 million from $2.6 million, fee-for-service revenue rose to $23.0 million from $17.9 million, and risk pool settlements and incentives reached $21.8 million, compared with $15.4 million.

Care Partners growth did not translate into higher segment profit

Care Partners revenue rose 48%, but operating income declined 14% to $42.9 million. This indicates that the additional revenue carried a weaker profit contribution than the segment’s prior-year business, although the earnings release did not provide a detailed explanation for the decline.

At the consolidated level, the expansion of Care Enablement and relatively limited growth in general and administrative expenses helped offset the pressure. Consolidated operating income consequently increased faster than revenue even as the largest segment’s operating profit moved lower.

Profitability, cash flow, and the balance sheet

Interest expense increased to $16.0 million from $7.4 million in Q2, absorbing part of the improvement in operating income. Acquisition-related intangible amortization also rose to $13.8 million from $6.2 million and contributed to the difference between GAAP and adjusted earnings.

Cash flow figures were provided for the first six months rather than Q2 alone. Six-month operating cash flow was $100.8 million, down about 6% from $107.5 million, while free cash flow declined about 10% to $92.9 million from $103.0 million. That occurred even as six-month GAAP net income increased to $31.6 million from $16.4 million. Changes in operating assets and liabilities contributed $18.9 million to operating cash flow, compared with $51.6 million a year earlier, helping explain the softer cash conversion.

Cash and equivalents ended June at $400.8 million, down from $429.5 million at the end of 2025. Astrana used $120.0 million in financing activities during the first half, including $103.9 million of debt repayments. Total current and long-term debt decreased by about $102.3 million to approximately $936.5 million.

Receivables increased to $465.1 million from $374.5 million at year-end, while medical liabilities rose to $415.8 million from $335.7 million. These working-capital balances will be relevant to whether cash generation strengthens during the second half.

2026 guidance

Astrana raised its full-year adjusted EBITDA outlook while reaffirming its revenue and free cash flow ranges. Management said it was increasing the EBITDA guidance even while reinvesting a substantial portion of first-half outperformance in growth opportunities; the prior EBITDA range was not included in the release.

The full-year free cash flow outlook is based on projected operating cash flow of $125 million to $145 million and capital expenditures of $12.5 million to $20 million.

Management commentary

CEO Brandon Sim said Astrana was seeing accelerating demand from providers and payers for its platform. Management linked that demand to the quarter’s growth and said the first-half performance supported the higher adjusted EBITDA outlook, despite plans for additional reinvestment.

Astrana also continued expanding its Medicare Advantage presence through agreements in Hawaii and Texas. The Texas agreement added approximately 3,000 Medicare Advantage professional-risk lives. Separately, affiliated accountable care organizations generated $120.4 million of gross shared savings for the 2024 performance year.

Recent insider transactions

The provided insider dataset reports no open-market insider purchases or sales in its six-month summary. It separately identifies the following derivative exercises, which should not be treated as discretionary open-market purchases.

The ten most recent additional entries in the supplied dataset were stock grants reported in April and June 2026 with a stated transaction value of zero.

Risks investors should watch

• Care Partners profitability: Revenue in the largest segment increased 48%, but operating income fell 14%. Continued divergence could limit the earnings benefit from companywide growth.
• Cash conversion: First-half operating cash flow and free cash flow declined despite higher net income. Receivables and medical liabilities also increased substantially from year-end.
• Interest and debt burden: Astrana reduced debt during the first half, but Q2 interest expense still more than doubled year over year to $16.0 million.
• GAAP versus adjusted earnings: Adjusted diluted EPS of $0.80 was twice GAAP diluted EPS of $0.40. Acquisition amortization, stock compensation, and other adjustments remain material to reported profitability.
• Reinvestment execution: Management plans to reinvest part of its first-half outperformance while pursuing growth. The returns from that spending will affect whether revenue expansion produces sustained margin and cash-flow improvement.

Summary

Astrana’s Q2 2026 results combined 49% revenue growth with more than doubling attributable net income and diluted GAAP EPS. Care Enablement growth and controlled corporate expense supported consolidated operating profit, but declining Care Partners operating income and softer first-half cash conversion temper the picture. The next priorities are execution against the raised adjusted EBITDA outlook, improved profitability in Care Partners, and stronger conversion of earnings into cash flow.