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      Astrana Health, Inc. Reports Fourth Quarter and Year-End 2023 Results

      ameh logo (PRNewsfoto/Apollo Medical Holdings, Inc.)

      News provided by

      Astrana Health, Inc.

      Feb 27, 2024, 16:05 ET

      Share this article

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      Company to Host Conference Call on Tuesday, Feb. 27, 2024, at 2:30 p.m. PT/5:30 p.m. ET

      ALHAMBRA, Calif., Feb. 27, 2024 /PRNewswire/ -- Astrana Health, Inc. (together with its subsidiaries and affiliated entities, "Astrana") (NASDAQ: ASTH), a leading provider-centric, technology-powered healthcare company focused on enabling providers in the successful delivery of value-based care, today announced its consolidated financial results for the fourth quarter and year ended December 31, 2023.

      "We are proud to announce another year marked by rapid scaling of our unique care model to empower providers and improve healthcare for local communities at Astrana Health. We coupled that with robust financial achievements, ensuring that our growth efforts are sustainable and maintaining a focus on profitability. We continue to execute against our strategic roadmap: 1) focusing on expanding our membership base across existing and new geographies, 2) increasing the level of accountability and risk we are responsible for in our value-based care contracts, 3) empowering our providers to achieve superior patient outcomes, and 4) executing strategic acquisitions to further accelerate our growth trajectory for the foreseeable future," said Brandon K. Sim, President and Chief Executive Officer of Astrana Health.

      Financial Highlights for the Year Ended December 31, 2023:

      All comparisons are to year ended December 31, 2022 unless otherwise stated.

      • Total revenue of $1,386.7 million, up 21% from $1,144.2 million
      • Care Partners revenue of $1,300.1 million, up 24% from $1,051.5 million
      • Net income attributable to Astrana of $60.7 million, up 34% from $45.2 million
      • Earnings per share — diluted ("EPS — diluted") of $1.29, up 30% from $0.99 per share
      • Adjusted EBITDA(1) of $146.6 million, up 5% from $140.0 million

      (1) See "Reconciliation of Net Income to EBITDA, Adjusted EBITDA and Adjusted EBITDA Margin" and "Use of Non-GAAP Financial Measures" below for additional information.

      Financial Highlights for Fourth Quarter 2023:

      All comparisons are to the quarter ended December 31, 2022 unless otherwise stated.

      • Total revenue of $353.0 million, up 20% from $294.2 million
      • Care Partners revenue of $333.7 million, up 24% from $269.3 million
      • Net income attributable to Astrana of $12.4 million, compared to a loss of $3.7 million
      • EPS — diluted of $0.26, compared to $(0.08) per share
      • Adjusted EBITDA(1) of $29.0 million, up 23% from $23.7 million

      (1) See "Reconciliation of Net Income to EBITDA, Adjusted EBITDA and Adjusted EBITDA Margin" and "Use of Non-GAAP Financial Measures" below for additional information.

      Recent Operating Highlights

      • On February 26, 2024 the Company changed its name from Apollo Medical Holdings, Inc. to Astrana Health, Inc. Alongside the corporate name change, the Company's common stock is trading under the new symbol "ASTH" on the NASDAQ.
      • In November 2023, the Company entered into an Asset and Equity Purchase Agreement (the "Purchase Agreement") to acquire the partnership interests of Advanced Health Management Systems, L.P. ("AHMS") and certain assets of Community Family Care Medical Group IPA, Inc. ("CFC"), which acquisitions the Company expected would occur in two separate closings. In November 2023, AHM (as defined below) also entered into a Stock Purchase Agreement (the "I Health Purchase Agreement") to purchase 25% of the outstanding shares of common stock of I Health, Inc. ("I Health"). On January 31, 2024, the first closing under the Purchase Agreement occurred, and the Company completed its acquisition of CFC's assets. CFC IPA manages the healthcare of over 200,000 members in the Los Angeles, California area, serving patients across Medicare, Medicaid, and Commercial payers. The Company expects to complete the second closing under the Purchase Agreement and acquire the outstanding general and limited partnership interests of AHMS during the first quarter of 2024, subject to obtaining required regulatory approvals. It is currently expected that the I Health Purchase Agreement closing will occur during the first quarter of 2024.
      • On January 29, 2024, the Company announced its strategic long-term partnership with BASS Medical Group, one of the largest multi-specialty medical groups in the Greater San Francisco Bay Area. Together, the two organizations will aim to bring high-quality care via value-based arrangements to patients of all insurance types, including Medicare, Medicaid, ACA Marketplace, and Commercial. Astrana has provided BASS Medical Group with a $20 million senior secured promissory note ("BASS secured promissory note") which is intended to be used, in partnership with Astrana, to continue to grow their footprint and invest in high-quality, high-value, and accessible primary and multi-specialty care for communities across California. The BASS secured promissory note matures on January 11, 2031 and has an interest rate per annum equal to 2.9% plus the Secured Overnight Financing Rate as administered by the Federal Reserve Bank of New York (or a successor administrator) compounded annually.
      • Effective January 19, 2024, the Company had the following leadership changes:
        • Thomas S. Lam, M.D., M.P.H., previously Co-Chief Executive Officer and President and a director, was appointed Vice Chairman of the Board;
        • Brandon K. Sim, M.S., previously Co-Chief Executive Officer, was appointed Chief Executive Officer and President; and
        • Chan Basho, M.B.A., previously Chief Financial Officer and Chief Strategy Officer, was appointed Chief Financial Officer and Chief Operating Officer.
        • In addition, Dinesh Kumar, M.D., was appointed Chief Medical Officer effective January 23, 2024.
      • On January 1, 2024, the Company's Employee Stock Purchase Plan ("ESPP") came into effect. The Company's ESPP allows eligible employees to contribute up a portion of their eligible earnings toward the semi-annual purchase of the Company's common stock at a discounted price, subject to an annual maximum dollar amount.
      • On January 1, 2024, in addition to participating in the ACO REACH Model, one of our other ACOs will participate in the Medicare Shared Savings Program ("MSSP"). The MSSP was created to promote accountability and improve coordination of care for Medicare beneficiaries. Unlike the ACO REACH Program, CMS continues to pay participant and preferred providers on a fee-for-service basis for Medicare covered services provided to MSSP Aligned Beneficiaries. Our shared savings or losses in managing our beneficiaries are generally determined on an annual basis after reconciliation with CMS.

      Segment Results for the Year Ended December 31, 2023:


      Year Ended December 31, 2023

      (in thousands)

      Care
      Partners


      Care
      Delivery


      Care
      Enablement


      Other


      Intersegment
      Elimination



      Corporate
      Costs


      Consolidated
      Total

      Total revenues

      $ 1,300,112


      $   119,904


      $    135,824


      $          937


      $       (170,116)



      $                 —


      $        1,386,661

      % change vs. prior year

      24 %


      25 %


      13 %

























      Cost of services

      1,182,484


      96,265


      59,075


      296


      (166,417)



      —


      1,171,703

      General and administrative(1)

      25,907


      17,766


      57,672


      3,752


      (7,923)



      33,171


      130,345

      Total expenses

      1,208,391


      114,031


      116,747


      4,048


      (174,340)



      33,171


      1,302,048
















      Income (loss) from operations

      $      91,721


      $       5,873


      $      19,077


      $     (3,111)


      $             4,224

      (2)


      $        (33,171)


      $             84,613

      % change vs. prior year

      8 %


      (35) %


      (29) %












      (1)

      Balance includes general and administrative expenses and depreciation and amortization.

      (2)

      Income from operations for the intersegment elimination represents rental income from segments renting from other segments. Rental income is presented within other income which is not presented in the table.

      Guidance:

      Astrana is providing the following guidance for total revenue, net income attributable to Astrana, Adjusted EBITDA, and EPS — diluted. These guidance assumptions are based on the Company's existing business, current view of existing market conditions and assumptions for the year ending December 31, 2024.

      ($ in millions)

      2024 Guidance Range


      Low


      High

      Total revenue

      $             1,650.0


      $             1,850.0

      Net income attributable to Astrana Health, Inc.

      $                  61.0


      $                  73.0

      Adjusted EBITDA

      $                165.0


      $                185.0

      EPS – diluted

      $                  1.28


      $                  1.52

      See "Guidance Reconciliation of Net Income to EBITDA and Adjusted EBITDA" and "Use of Non-GAAP Financial Measures" below for additional information. There can be no assurance that actual amounts will not be materially higher or lower than these expectations. See "Forward-Looking Statements" below for additional information.

      Conference Call and Webcast Information:

      Astrana will host a conference call at 2:30 p.m. PT/5:30 p.m ET (Tuesday, February 27, 2024), during which management will discuss the results of the fourth quarter and year ended December 31, 2023. To participate in the conference call, please use the following dial-in numbers about 5 minutes prior to the scheduled conference call time:

      U.S. & Canada (Toll-Free):

      +

      1 (877) 858-9810 or;


      +

      1 (201) 689-8517

      The conference call can also be accessed via webcast at: https://event.choruscall.com/mediaframe/webcast.html?webcastid=EM7HqFSl

      An accompanying slide presentation will be available in PDF format on the "IR Calendar" page of the Company's website (ir.astranahealth.com) after issuance of the earnings release and will be filed as an exhibit to Astrana's current report on Form 8-K to be filed with the SEC, accessible at www.sec.gov.

      Those who are unable to attend the live conference call may access the recording at the above webcast link, which will be made available shortly after the conclusion of the call.

      Note About Consolidated Entities

      The Company consolidates entities in which it has a controlling financial interest. The Company consolidates subsidiaries in which it holds, directly or indirectly, more than 50% of the voting rights, and variable interest entities ("VIEs") in which the Company is the primary beneficiary. Noncontrolling interests represent third party equity ownership interests in the Company's consolidated entities (including certain VIEs). The amount of net income attributable to noncontrolling interests is disclosed in the Company's consolidated statements of income.

      Note About Stockholders' Equity, Certain Treasury Stock and Earnings Per Share

      As of the date of this press release, 41,048 holdback shares have not been issued to certain former shareholders of the Company's subsidiary, Astrana Health Management, Inc. ("AHM"), formerly known as Network Medical Management, Inc., who were AHM shareholders at the time of closing of the merger, as they have yet to submit properly completed letters of transmittal to Astrana in order to receive their pro rata portion of Astrana's common stock and warrants as contemplated under that certain Agreement and Plan of Merger, dated December 21, 2016, among Astrana, AHM, Apollo Acquisition Corp. ("Merger Subsidiary") and Kenneth Sim, M.D., as amended, pursuant to which Merger Subsidiary merged with and into AHM, with AHM as the surviving corporation. Pending such receipt, such former AHM shareholders have the right to receive, without interest, their pro rata share of dividends or distributions with a record date after the effectiveness of the merger. The Company's consolidated financial statements have treated such shares of common stock as outstanding, given the receipt of the letter of transmittal is considered perfunctory and Astrana is legally obligated to issue these shares in connection with the merger.

      Shares of Astrana's common stock owned by Allied Physicians of California, a Professional Medical Corporation ("APC"), a VIE of the Company, are legally issued and outstanding but excluded from shares of common stock outstanding in the Company's consolidated financial statements, as such shares are treated as treasury shares for accounting purposes. Such shares, therefore, are not included in the number of shares of common stock outstanding used to calculate the Company's earnings per share.

       About Astrana Health
      Astrana is a leading provider-centric, technology-powered healthcare company enabling providers to deliver accessible, high-quality, and high-value care to all. Leveraging its proprietary end-to-end technology solutions, Astrana operates an integrated healthcare delivery platform that enables providers to successfully participate in value-based care arrangements, thus empowering them to deliver high quality care to patients in a cost-effective manner.

      Headquartered in Alhambra, California, Astrana serves over 10,000 providers and 900,000 Americans in value-based care arrangements. Its subsidiaries and affiliates include management services organizations (MSOs), affiliated independent practice associations (IPAs), accountable care organizations (ACOs), and care delivery entities across primary, multi-specialty, and ancillary care. For more information, please visit www.astranahealth.com.

      Forward-Looking Statements

      This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, such as statements about the Company's guidance for the year ending December 31, 2024, ability to meet operational goals, ability to meet expectations in deployment of care coordination and management capabilities, ability to decrease cost of care while improving quality and outcomes, ability to deliver sustainable revenue and EBITDA growth as well as long-term value, ability to respond to the changing environment, and successful implementation of strategic growth plans, acquisition strategy, and merger integration efforts. Forward-looking statements reflect current views with respect to future events and financial performance and therefore cannot be guaranteed. Such statements are based on the current expectations and certain assumptions of the Company's management, and some or all of such expectations and assumptions may not materialize or may vary significantly from actual results. Actual results may also vary materially from forward-looking statements due to risks, uncertainties and other factors, known and unknown, including the risk factors described from time to time in the Company's reports to the SEC, including, without limitation the risk factors discussed in the Company's Annual Report on Form 10-K for the year ended December 31, 2023, which will be filed with the SEC, and any subsequent quarterly reports on Form 10-Q. Any forward-looking statement made by the Company in this release speaks only as of the date on which it is made. The Company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future developments or otherwise, except as may be required by any applicable securities laws.

      FOR MORE INFORMATION, PLEASE CONTACT:

      Investor Relations
      Asher Dewhurst
      [email protected]

      ASTRANA HEALTH, INC.

       CONSOLIDATED BALANCE SHEETS

      (IN THOUSANDS, EXCEPT SHARE AND PER SHARE DATA)








      December 31,


      December 31,



      2023


      2022






      Assets










      Current assets





      Cash and cash equivalents


      $           293,807


      $           288,027

      Investment in marketable securities


      2,498


      5,567

      Receivables, net


      76,780


      49,631

      Receivables, net – related parties


      58,980


      65,147

      Income taxes receivable


      10,657


      —

      Other receivables


      1,335


      1,834

      Prepaid expenses and other current assets


      17,450


      14,798

      Loans receivable


      —


      996

      Loans receivable – related party


      —


      2,125






      Total current assets


      461,507


      428,125






      Non-current assets





      Land, property and equipment, net


      7,171


      108,536

      Intangible assets, net


      71,648


      76,861

      Goodwill


      278,831


      269,053

      Income taxes receivable


      15,943


      15,943

      Loans receivable, non-current


      26,473


      —

      Investments in other entities – equity method


      25,774


      40,299

      Investments in privately held entities


      6,396


      2,396

      Restricted cash


      345


      —

      Operating lease right-of-use assets


      37,396


      20,444

      Other assets


      1,877


      4,556






      Total non-current assets


      471,854


      538,088






      Total assets(1)


      $           933,361


      $           966,213






      Liabilities, Mezzanine Equity (Deficit), and Stockholders' Equity










      Current liabilities










       Accounts payable and accrued expenses


      $             59,949


      $             49,562

       Fiduciary accounts payable


      7,737


      8,065

       Medical liabilities


      106,657


      81,255

       Income taxes payable


      —


      4,279

       Dividend payable


      638


      664

       Finance lease liabilities


      646


      594

       Operating lease liabilities


      4,607


      3,572

      Current portion of long-term debt


      19,500


      619

      Other liabilities


      18,940


      —






      Total current liabilities


      218,674


      148,610






      Non-current liabilities





      Deferred tax liability


      4,072


      14,217

      Finance lease liabilities, net of current portion


      1,033


      1,275

      Operating lease liabilities, net of current portion


      36,289


      19,915

      Long-term debt, net of current portion and deferred financing costs


      258,939


      203,389

      Other long-term liabilities


      3,586


      20,260






      Total non-current liabilities


      303,919


      259,056






      Total liabilities(1)


      522,593


      407,666






      Mezzanine (deficit) equity





      Noncontrolling interest in Allied Physicians of California, a Professional Medical Corporation


      (205,883)


      14,237






      Stockholders' equity





      Series A Preferred stock, par value $0.001; 5,000,000 shares authorized (inclusive of

       Series B Preferred stock); 1,111,111 issued and zero outstanding


      —


      —

      Series B Preferred stock, par value $0.001; 5,000,000 shares authorized (inclusive of

       Series A Preferred stock); 555,555 issued and zero outstanding


      —


      —

      Common stock, par value $0.001; 100,000,000 shares authorized, 46,843,743 and

       46,575,699 shares outstanding, excluding 10,584,340 and 10,299,259 treasury shares,

       at December 31, 2023 and 2022, respectively


      47


      47

      Additional paid-in capital


      371,037


      360,097

      Retained earnings


      243,134


      182,417



      614,218


      542,561






      Non-controlling interest


      2,433


      1,749






        Total stockholders' equity


      616,651


      544,310






      Total liabilities, mezzanine equity (deficit), and stockholders' equity


      $           933,361


      $           966,213



      (1)

      The Company's consolidated balance sheets include the assets and liabilities of its consolidated VIEs. The consolidated balance sheets include total assets that can be used only to settle obligations of the Company's consolidated VIEs totaling $540.8 million and $579.8 million as of December 31, 2023 and December 31, 2022, respectively, and total liabilities of the Company's consolidated VIEs for which creditors do not have recourse to the general credit of the primary beneficiary of $146.0 million and $149.6 million as of December 31, 2023 and December 31, 2022, respectively. These VIE balances do not include $273.2 million of investment in affiliates and $107.3 million of amounts due to affiliates as of December 31, 2023 and $304.8 million of investment in affiliates and $11.6 million of amounts due from affiliates as of December 31, 2022 as these are eliminated upon consolidation and not presented within the consolidated balance sheets.

      ASTRANA HEALTH, INC.

      CONSOLIDATED STATEMENTS OF INCOME

      (IN THOUSANDS, EXCEPT PER SHARE AMOUNTS)




      Three Months Ended

      December 31,


      Year Ended

       December 31,



      2023


      2022


      2023


      2022

      Revenue









      Capitation, net


      $       309,184


      $       252,878


      $    1,215,614


      $       930,131

      Risk pool settlements and incentives


      14,863


      15,537


      63,468


      117,254

      Management fee income


      6,390


      10,607


      38,677


      41,094

      Fee-for-service, net


      18,442


      13,823


      59,658


      49,517

      Other income


      4,157


      1,363


      9,244


      6,167










      Total revenue


      353,036


      294,208


      1,386,661


      1,144,163










      Operating expenses









      Cost of services, excluding depreciation and amortization


      314,055


      253,119


      1,171,703


      944,685

      General and administrative expenses


      37,949


      24,446


      112,597


      77,670

      Depreciation and amortization


      4,902


      4,063


      17,748


      17,543










      Total expenses


      356,906


      281,628


      1,302,048


      1,039,898










      (Loss) income from operations


      (3,870)


      12,580


      84,613


      104,265










      Other (expense) income









      Income from equity method investments


      2,475


      1,225


      5,579


      5,622

      Interest expense


      (5,422)


      (2,572)


      (16,102)


      (7,920)

      Interest income


      4,591


      1,286


      14,208


      1,976

      Unrealized gain (loss) on investments


      1,294


      (3,680)


      (4,581)


      (21,271)

      Other income


      1,856


      1,616


      6,121


      3,944










      Total other income (expense), net


      4,794


      (2,125)


      5,225


      (17,649)










      Income before provision for income taxes


      924


      10,455


      89,838


      86,616










      Provision for income taxes


      1,018


      11,338


      31,989


      40,875










      Net (loss) income


      (94)


      (883)


      57,849


      45,741










      Net (loss) income attributable to noncontrolling interests


      (12,450)


      2,845


      (2,868)


      570










      Net income (loss) attributable to Astrana Health, Inc.


      $         12,356


      $         (3,728)


      $         60,717


      $         45,171










      Earnings (losses) per share – basic


      $              0.26


      $            (0.08)


      $              1.30


      $              1.00










      Earnings (losses) per share – diluted


      $              0.26


      $            (0.08)


      $              1.29


      $              0.99

      Reconciliation of Net Income to EBITDA, Adjusted EBITDA, and Adjusted EBITDA Margin(1)

















      Three Months Ended

       December 31,



      Year Ended

       December 31,


       (in thousands)


      2023



      2022



      2023



      2022















      Net (loss) income


      $          (94)



      $       (883)



      $    57,849



      $    45,741


      Interest expense


      5,422



      2,572



      16,102



      7,920


      Interest income


      (4,591)



      (1,286)



      (14,208)



      (1,976)


      Provision for income taxes


      1,018



      11,338



      31,989



      40,875


      Depreciation and amortization


      4,902



      4,063



      17,748



      17,543


      EBITDA


      $      6,657



      $    15,804



      $  109,480



      $  110,103















      Income from equity method investments


      (1,989)



      (1,322)

      (2)


      $    (5,149)



      (5,680)

      (2)

      Other, net


      4,721

      (3)


      1,927

      (4)


      $      6,228

      (3)


      3,309

      (4)

      Stock-based compensation


      8,676



      5,624



      $    22,040



      16,101


      APC excluded assets costs


      10,949



      1,619



      $    13,988



      16,193


      Adjusted EBITDA


      $    29,014



      $    23,652



      $  146,587



      $  140,026















      Total Revenue


      $  353,036



      $  294,208



      $  1,386,661



      $  1,144,163















      Adjusted EBITDA margin


      8 %



      8 %



      11 %



      12 %




      (1)

      The Company defines Adjusted EBITDA margin as Adjusted EBITDA over total revenue.

      (2)

      Certain APC minority interests where APC owns the asset but not the right to the dividends were reclassified from APC excluded asset costs to income from equity method investments.

      (3)

      Other, net for the three and twelve months ended December 31, 2023 consists of nonrecurring transaction costs and tax restructuring fees incurred, non-cash gains and losses related to the changes in the fair value of our financing obligation to purchase the remaining equity interests, contingent liabilities,  and the Company's Collar Agreement, and excise tax related to a nonrecurring buyback of the Company's stock from APC.

      (4)

      Other, net for the three and twelve months ended December 31, 2022 consists of one-time transaction costs incurred and non-cash gains and losses related to the changes in the fair value of our financing obligation to purchase the remaining equity interests and contingent considerations.

      Guidance Reconciliation of Net Income to EBITDA and Adjusted EBITDA




      (in thousands)


      2024 Guidance Range



      Low


      High

      Net income


      $             71,500


      $          85,500

      Interest expense, net


      14,500


      12,500

      Provision for income taxes


      36,500


      44,500

      Depreciation and amortization


      14,500


      14,500

      EBITDA


      137,000


      157,000






      Income from equity method investments


      (5,000)


      (5,000)

      Other, net


      6,000


      6,000

      Stock-based compensation


      27,000


      27,000

      Adjusted EBITDA


      $           165,000


      $           185,000

      Use of Non-GAAP Financial Measures

      This press release contains the non-GAAP financial measures EBITDA, Adjusted EBITDA and Adjusted EBITDA margin, of which the most directly comparable financial measure presented in accordance with U.S. generally accepted accounting principles ("GAAP") is net income. These measures are not in accordance with, or alternatives to GAAP, and may be different from other non-GAAP financial measures used by other companies. The Company uses Adjusted EBITDA as a supplemental performance measure of our operations, for financial and operational decision-making, and as a supplemental means of evaluating period-to-period comparisons on a consistent basis. Adjusted EBITDA is calculated as earnings before interest, taxes, depreciation, and amortization, excluding income or loss from equity method investments, non-recurring and non-cash transactions, stock-based compensation, and APC excluded assets costs. The Company defines Adjusted EBITDA margin as Adjusted EBITDA over total revenue.

      The Company believes the presentation of these non-GAAP financial measures provides investors with relevant and useful information, as it allows investors to evaluate the operating performance of the business activities without having to account for differences recognized because of non-core or non-recurring financial information. When GAAP financial measures are viewed in conjunction with non-GAAP financial measures, investors are provided with a more meaningful understanding of the Company's ongoing operating performance. In addition, these non-GAAP financial measures are among those indicators the Company uses as a basis for evaluating operational performance, allocating resources, and planning and forecasting future periods. Non-GAAP financial measures are not intended to be considered in isolation, or as a substitute for, GAAP financial measures. Other companies may calculate both EBITDA and Adjusted EBITDA differently, limiting the usefulness of these measures for comparative purposes. To the extent this release contains historical or future non-GAAP financial measures, the Company has provided corresponding GAAP financial measures for comparative purposes. The reconciliation between certain GAAP and non-GAAP measures is provided above.

      SOURCE Astrana Health, Inc.

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