Revenue growth accelerated to 48.5% YoY in 2026Q2, but gross margin compressed to 10.7% from 11.9% a year earlier, and net margin remains thin at 2.0%, indicating a mix shift toward lower-margin capitated contracts.
Astrana Health, Inc. (ASTH) annual income statement — 10-year revenue, gross profit & net income history
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Mar'16 |
|---|
| Sales/Revenue | 3.84B | 3.18B | 2.03B | 1.39B | 1.14B | 773.91M | 370.25M | 560.62M | 519.91M | 357.75M | 44.05M |
| Revenue Growth % | 58.91% | 56.39% | 46.72% | 21.19% | 47.84% | 109.03% | -33.96% | 7.83% | 45.33% | 712.16% | - |
| Cost of Goods Sold | 3.49B | 2.89B | 1.76B | 1.17B | 944.68M | 596.14M | 348.54M | 467.81M | 380.44M | 293.73M | 34.35M |
| COGS % of Revenue | - | 90.7% | 86.66% | 84.5% | 82.57% | 77.03% | 94.14% | 83.44% | 73.17% | 82.11% | 77.99% |
| Gross Profit | 354.53M | 295.78M | 271.39M | 214.96M | 199.48M | 177.77M | 21.7M | 92.81M | 139.47M | 64.02M | 9.7M |
| Gross Margin % | 9.22% | 9.3% | 13.34% | 15.5% | 17.43% | 22.97% | 5.86% | 16.56% | 26.83% | 17.89% | 22.01% |
| Gross Profit Growth % | - | 8.99% | 26.25% | 7.76% | 12.21% | 719.04% | -76.61% | -33.45% | 117.87% | 560.19% | - |
| Operating Expenses | 254.07M | 217.26M | 182.04M | 130.34M | 95.21M | 79.59M | 15.62M | 60.39M | 47.24M | 26.44M | 16.28M |
| OpEx % of Revenue | - | 6.83% | 8.95% | 9.4% | 8.32% | 10.28% | 4.22% | 10.77% | 9.09% | 7.39% | 36.96% |
| Selling, General & Admin | 238.52M | 217.26M | 154.11M | 112.6M | 77.67M | 62.08M | 15.59M | 41.48M | 47.24M | 26.44M | 16.28M |
| SG&A % of Revenue | - | 6.83% | 7.57% | 8.12% | 6.79% | 8.02% | 4.21% | 7.4% | 9.09% | 7.39% | 36.96% |
| Research & Development | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| R&D % of Revenue | - | - | - | - | - | - | - | - | - | - | - |
| Other Operating Expenses | 1000K | 0 | 27.93M | 17.75M | 17.54M | 17.52M | 26K | 18.91M | 0 | 0 | 0 |
| Operating Income | 100.45M | 78.53M | 89.35M | 84.61M | 104.27M | 98.18M | 6.09M | 32.42M | 92.23M | 37.58M | -6.58M |
| Operating Margin % | 2.61% | 2.47% | 4.39% | 6.1% | 9.11% | 12.69% | 1.64% | 5.78% | 17.74% | 10.5% | -14.94% |
| Operating Income Growth % | - | -12.12% | 5.6% | -18.85% | 6.2% | 1513.19% | -81.23% | -64.85% | 145.44% | 670.91% | - |
| EBITDA | 156.81M | 124.27M | 117.28M | 102.36M | 121.81M | 115.7M | 24.44M | 50.7M | 111.53M | 56.65M | -6.23M |
| EBITDA Margin % | 4.08% | 3.91% | 5.76% | 7.38% | 10.65% | 14.95% | 6.6% | 9.04% | 21.45% | 15.84% | -14.14% |
| EBITDA Growth % | 58.06% | 5.97% | 14.57% | -15.97% | 5.28% | 373.47% | -51.8% | -54.54% | 96.87% | 1009.26% | - |
| D&A (Non-Cash Add-back) | 47.48M | 45.75M | 27.93M | 17.75M | 17.54M | 17.52M | 18.35M | 18.28M | 19.3M | 19.08M | 351.4K |
| EBIT | 127.43M | 89.53M | 113.92M | 105.94M | 94.54M | 83.14M | 11.39M | 30.57M | 83.19M | 49.79M | -7.7M |
| Net Interest Income | -50.1M | -37.77M | -18.59M | -1.89M | -5.94M | -3.82M | -2.12M | -2.71M | 698K | 935.51K | -542.3K |
| Interest Income | 17.23M | 12.16M | 14.51M | 14.21M | 1.98M | 1.57M | 405K | 2.02M | 1.26M | 1.02M | 0 |
| Interest Expense | 67.34M | 49.93M | 33.1M | 16.1M | 7.92M | 5.39M | 2.53M | 4.73M | 560.51K | 79.69K | 542.3K |
| Other Income/Expense | -40.36M | -38.92M | -8.53M | 5.22M | -17.65M | -20.43M | 2.78M | -6.58M | -9.6M | 12.13M | -1.66M |
| Pretax Income | 60.1M | 39.61M | 80.82M | 89.84M | 86.62M | 77.75M | 8.87M | 25.84M | 82.63M | 49.71M | -8.24M |
| Pretax Margin % | 1.56% | 1.24% | 3.97% | 6.48% | 7.57% | 10.05% | 2.4% | 4.61% | 15.89% | 13.9% | -18.72% |
| Income Tax | 20.87M | 15.53M | 30.89M | 31.99M | 40.88M | 31.69M | 9.18M | 8.17M | 22.36M | 3.89M | -71.04K |
| Effective Tax Rate % | 34.73% | 39.21% | 38.22% | 35.61% | 47.19% | 40.76% | 103.54% | 31.61% | 27.06% | 7.82% | 0.86% |
| Net Income | 40.55M | 22.49M | 43.15M | 60.72M | 45.17M | 68.92M | -23.75M | 14.12M | 10.84M | 25.8M | -9.34M |
| Net Margin % | 1.05% | 0.71% | 2.12% | 4.38% | 3.95% | 8.91% | -6.42% | 2.52% | 2.08% | 7.21% | -21.21% |
| Net Income Growth % | 60.53% | -47.89% | -28.93% | 34.42% | -34.46% | 390.18% | -268.26% | 30.28% | -58.01% | 376.13% | - |
| Net Income (Continuing) | 39.22M | 24.08M | 49.93M | 57.85M | 45.74M | 46.05M | -314K | 17.67M | 60.27M | 45.82M | -8.17M |
| Discontinued Operations | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Minority Interest | -231.65M | -220.96M | -198.55M | -203.45M | 15.99M | 62.48M | 114.32M | 169.51M | 226.12M | 176.37M | 2.74M |
| EPS (Diluted) | 0.81 | 0.46 | 0.90 | 1.29 | 0.99 | 1.52 | 1.01 | 0.39 | 0.29 | 0.90 | -1.79 |
| EPS Growth % | 57.21% | -48.89% | -30.23% | 30.3% | -34.87% | 50.5% | 158.97% | 34.48% | -67.78% | 150.28% | - |
| EPS (Basic) | - | 0.46 | 0.91 | 1.30 | 1.00 | 1.57 | 1.04 | 0.41 | 0.33 | 1.01 | 0.00 |
| Diluted Shares Outstanding | 49.78M | 49.37M | 48.22M | 47.07M | 45.6M | 45.4M | 37.45M | 36.4M | 37.91M | 28.66M | 5.21M |
| Basic Shares Outstanding | 49.12M | 49.08M | 47.69M | 46.71M | 44.97M | 43.83M | 36.53M | 34.71M | 32.89M | 25.53M | 1 |
| Dividend Payout Ratio | - | 35.06% | 9.35% | 102.24% | 31.06% | 45.11% | - | 437.21% | 163.9% | 40.49% | - |
Quick answers to the most common questions about buying ASTH stock.
For fiscal year 2025, Astrana Health, Inc. (ASTH) reported total revenue of $3.18B. This represents a 7123.3% increase compared to $44.0M in 2015.
Astrana Health, Inc. (ASTH) is profitable, generating $22.5M in net income for the fiscal year ending 2025 with a net profit margin of 0.7%.
Astrana Health, Inc. (ASTH) reported an operating income of $78.5M, resulting in an operating profit margin of 2.5%. This margin reflects the operational efficiency of the business before interest and taxes.
Astrana Health, Inc. (ASTH) generated $295.8M in gross profit for the year, representing a gross profit margin of 9.3%. This demonstrates the company's core pricing power and production efficiency.
Key Metrics
Top Statement Risk
Thin margins and high leverage
Metrics are mathematically derived from official filings.
Top-Line Surge Outpaces Margin Build
Revenue grew 48.5% YoY in 2026Q2 to $972.5M, per the latest quarterly report, marking the fourth consecutive quarter of accelerating growth, though gross margin compressed to 10.7% from 11.9% a year earlier.
The 56.4% YoY growth in 2026Q1 and 48.5% in 2026Q2 indicate a sustained acceleration, likely driven by new contract wins and member expansion. However, the sequential revenue increase from $965.1M to $972.5M is modest, suggesting growth may be plateauing at current levels. The gross margin decline from 11.9% in 2025Q2 to 10.7% in 2026Q2 implies that new revenue is coming at lower margins, possibly from lower-acuity or less efficient contracts.
Gross Margin Compression Signals Mix Shift
Gross margin fell to 10.7% in 2026Q2 from 11.9% in 2025Q2, as reported in the income statement, indicating that the revenue mix is shifting toward lower-margin capitated contracts, pressuring the already thin 0.71% net margin.
The structural pass-through nature of the business means gross margin is a direct proxy for medical loss ratio (MLR) efficiency. The decline from 15.4% in 2024Q3 to 10.7% in 2026Q2 suggests that either utilization is rising or the company is taking on more risk with less favorable terms. This trend, if sustained, could erode the already minimal net profitability, making the company highly sensitive to any further MLR deterioration.
Operating Leverage Yet to Materialize
Operating income grew 69% YoY in 2026Q2 to $34.3M, but operating margin only expanded to 3.5% from 3.1% a year ago, per the latest financials, indicating that SG&A costs are scaling nearly in line with revenue.
The 56% revenue growth has not translated into disproportionate operating income growth; operating margin has remained in the 3-3.5% range over the past two quarters. SG&A in 2026Q2 was $54.1M, up from $50.7M in 2025Q2, a 6.7% increase, which is far below the revenue growth rate, suggesting some cost discipline. However, the absolute level of SG&A as a percentage of revenue (5.6%) is still high, and the company has not yet demonstrated the operating leverage that would be expected from scaling a technology-enabled platform.
Adjusted vs. GAAP Divergence Raises Questions
GAAP EPS of $0.40 in 2026Q2 missed consensus by $0.33, yet management raised full-year adjusted EBITDA guidance, per recent disclosures, suggesting the miss may stem from non-cash charges like acquisition amortization rather than operational weakness.
Stock-based compensation (SBC) of $21.7M in 2026Q2 is substantial, representing 2.2% of revenue and more than half of net income, which inflates reported EPS relative to cash earnings. The large EPS miss versus the raised guidance indicates that the market's focus on adjusted metrics may be obscuring the impact of SBC and other non-operating items. Investors should monitor the sustainability of adjusted earnings, as the gap between GAAP and adjusted figures appears to be widening.
Medical Claims Dominate Cost Structure
COGS, primarily medical claims, consumed 89.3% of revenue in 2026Q2, as per the income statement, leaving a gross margin of just 10.7%, which underscores the high variable cost nature of the risk-bearing model.
The cost structure is heavily weighted toward medical claims, which are inherently variable and difficult to control in the short term. SG&A, at $54.1M, is relatively modest but includes significant SBC, which is a non-cash expense. The company's ability to manage MLR is critical; any uptick in utilization could quickly erase the thin operating profit. The recent trend of declining gross margin suggests that cost management is not keeping pace with revenue growth.
Growth at Any Cost May Undermine Value
Despite 56% revenue growth, net margin remains at 2.0% in 2026Q2, and debt-to-equity has risen to 1.93, per the latest balance sheet, suggesting that the company is financing aggressive expansion with leverage while profitability lags.
Short-sellers would argue that the company is prioritizing top-line growth over shareholder returns, as evidenced by the persistent thin margins and the reliance on debt to fund operations. The 56% revenue growth may be driven by low-margin contracts that do not generate adequate returns on capital, as reflected in the ROE of only 4.2%. If utilization rates rise or reimbursement rates are cut, the company has little buffer to absorb the shock, potentially leading to significant earnings volatility. The raised guidance may be overly optimistic given the current margin trajectory.