Astrana Health, Inc. Reports Fourth Quarter and Year-End 2023 Results
Company to Host Conference Call on
"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
All comparisons are to year ended
- 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
- 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 fromApollo Medical Holdings, Inc. toAstrana 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 ofAdvanced Health Management Systems, L.P. ("AHMS") and certain assets ofCommunity Family Care Medical Group IPA, Inc. ("CFC"), which acquisitions the Company expected would occur in two separate closings. InNovember 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 ofI Health, Inc. ("I Health "). OnJanuary 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 theLos 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 withBASS Medical Group , one of the largest multi-specialty medical groups in theGreater 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 providedBASS 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 acrossCalifornia . The BASS secured promissory note matures onJanuary 11, 2031 and has an interest rate per annum equal to 2.9% plus the Secured Overnight Financing Rate as administered by theFederal 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; andChan 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 effectiveJanuary 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
|
Year Ended |
|||||||||||||
(in thousands) |
Care |
|
Care |
|
Care |
|
Other |
|
Intersegment |
|
|
Corporate |
|
Consolidated |
Total revenues |
|
|
$ 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
($ in millions) |
2024 |
||
|
Low |
|
High |
Total revenue |
$ 1,650.0 |
|
$ 1,850.0 |
Net income attributable to |
$ 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
|
+ |
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
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,
Shares of Astrana's common stock owned by Allied Physicians of
About
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
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
FOR MORE INFORMATION, PLEASE CONTACT:
Investor Relations
investors@astranahealth.com
|
||||
CONSOLIDATED BALANCE SHEETS |
||||
(IN THOUSANDS, EXCEPT SHARE AND PER SHARE DATA) |
||||
|
|
|
|
|
|
|
|
|
|
|
|
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 |
|
|
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 |
|
(205,883) |
|
14,237 |
|
|
|
|
|
Stockholders' equity |
|
|
|
|
Series A Preferred stock, par value Series B Preferred stock); 1,111,111 issued and zero outstanding |
|
— |
|
— |
Series B Preferred stock, par value Series A Preferred stock); 555,555 issued and zero outstanding |
|
— |
|
— |
Common stock, par value 46,575,699 shares outstanding, excluding 10,584,340 and 10,299,259 treasury shares,
at |
|
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 |
|
||||||||
CONSOLIDATED STATEMENTS OF INCOME |
||||||||
(IN THOUSANDS, EXCEPT PER SHARE AMOUNTS) |
||||||||
|
||||||||
|
|
Three Months Ended
|
|
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 |
|
$ 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 |
(4) |
Other, net for the three and twelve months ended |
Guidance Reconciliation of Net Income to EBITDA and Adjusted EBITDA |
||||
|
|
|
||
(in thousands) |
|
2024 |
||
|
|
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
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.
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