Astrana Health, Inc. (ASTH) · Nov 5, 2026 · Earnings
Miss — Adjusted EPS $0.71 vs ~$0.79 consensus
Astrana’s Q3 earnings were mixed: revenue met expectations and guidance narrowed, but adjusted EPS fell short of consensus.
Astrana is scaling a physician-centered, risk-bearing healthcare platform serving roughly 1.5 million value-based-care patients, while shifting more revenue and members into full-risk contracts and integrating technology and acquisitions. That strategy was already established before this release; the new information is how the model performed in Q3 and how management reset the range for the finish.
The quarter was operationally solid but missed the cleanest earnings benchmark. Revenue of $1.024 billion was essentially in line with the published consensus of about $1.02 billion, while adjusted EBITDA reached $77.2 million, near the top of the company’s prior $72.5 million–$77.5 million quarterly range. But adjusted EPS of $0.71 trailed the published consensus of roughly $0.79, making this an earnings miss despite strong year-over-year growth.
| Q3 2026 | Q3 2025 | Consensus / prior guide | |
|---|---|---|---|
| Revenue (Financial Highlights) | $1,023.6M (+7.1%) | $956.0M | ~$1,020M |
| Adjusted EPS (Selected Financial Results) | $0.71 (+4.4%) | $0.68 | ~$0.79 |
| Adjusted EBITDA (Adjusted EBITDA reconciliation) | $77.2M (+12.7%) | $68.5M | $72.5M–$77.5M |
| Free cash flow, YTD (Cash Flow statement) | $105.4M (-4.6%) | $110.4M | — |
The more important business signal is tighter, not higher, full-year guidance. Astrana narrowed revenue to $3.9 billion–$4.0 billion from $3.8 billion–$4.1 billion, adjusted EBITDA to $261 million–$274 million from $255 million–$280 million, and free cash flow to $107.5 million–$130 million from $105 million–$132.5 million. This removes both ends of the previous ranges rather than raising the midpoint meaningfully; it signals greater confidence in the landing zone, not a material change in the growth story. The prior framework was already public after Q2. The filing states that the company is “narrowing guidance for total revenue, Adjusted EBITDA, and free cash flow for the year ending December 31, 2026.” 〔0〕
Underlying execution still supports the full-risk transition. Care Partners revenue rose 8%, Care Delivery rose 5%, and Care Enablement rose 5%; consolidated operating income more than doubled to $39.9 million. Management also said year-to-date medical-cost trend was below its roughly 5.2% full-year assumption, while 82% of expected 2026 capitation revenue is now tied to full-risk arrangements. The caveat is that free cash flow declined year over year and cash fell to $396.2 million from $429.5 million at year-end, so the stronger operating result has not translated into stronger cash generation yet.
The strategic story is advancing, but this filing does not rewrite it. Astrana continues to add Care Enablement clients, move members toward full-risk contracts, and expand through tuck-in acquisitions; the Georgia physician-association acquisition closed October 1, 2026. 〔1〕 The company’s operating platform is gaining scale, but the quarter’s adjusted-EPS miss and softer year-to-date free cash flow keep the release from being a clean upside surprise.
Bottom line: Astrana’s business remains on track, and tighter guidance adds confidence around execution, but the quarter itself missed adjusted-EPS expectations. This is a mixed update with modestly positive strategic progress, not a story-changing beat.
Q4 results and 2027 outlook
A buy-side analyst on every ticker — it reads every public company's filing the instant it drops and decodes it into plain English.
A buy-side analyst on every ticker — the whole market decoded the second it moves, before it's a headline. Free gives you a taste. Pro takes the cap off and opens the full read on every company.
by Signing in NOW, claim your FREE 14-day Pro trial!