Astrana Health, Inc. (NASDAQ:ASTH) Q1 2024 Earnings Call Transcript

Astrana Health, Inc. (NASDAQ:ASTH) Q1 2024 Earnings Call Transcript May 7, 2024

Astrana Health, Inc. isn’t one of the 30 most popular stocks among hedge funds at the end of the third quarter (see the details here).

Operator: Good day everyone and welcome to today’s Astrana Health First Quarter 2024 Earnings Call. At this time, all participants are in a listen-only mode. [Operator Instructions] Today’s speaker would be Brandon Sim, President and Chief Executive Officer of Astrana Health; and Chan Basho, Chief Operating and Financial Officer. A press release announcing Astrana Health Inc.’s results for the first quarter ended March 31, 2024 is available at the Investors section of the company’s website at www.astranahealth.com. The company will discuss certain non-GAAP measures during this call. Reconciliations to the most comparable GAAP measure are included in the press release. To provide some additional background on its results, the Company has made a supplemental deck available on its website.

A replay of this broadcast will also be made available at Astrana Health website after the conclusion of this call. Before we get started, I would like to remind everyone that this conference call and any accompanying information discussed herein contains certain forward-looking statements within the meaning of the Safe Harbor provision of the Private Securities Litigation Reform Act of 1995. These forward-looking statements can be identified by terms such as anticipate, believe, expect, future, plan, outlook and will and include among other things statements regarding the company’s guidance for the year ending December 31, 2024, continued growth, acquisition strategy, ability to deliver sustainable long-term value, ability to respond to the changing environment, operational focus, strategic growth plans and merger integration efforts.

Although the company believes that the expectations reflected in its forward-looking statements are reasonable as of today, those statements are subject to risks and uncertainties that could cause the actual results to differ dramatically from those projected. There can be no assurance that those expectations will prove to be correct. Information about the risks associated with investing in Astrana Health is included in its filings with the Securities and Exchange Commission, which we encourage you to review before making an investment decision. The company does not assume any obligation to update any forward-looking statements as a result of new information, future events changes in market conditions or otherwise, except as required by law.

Regarding the disclaimer language, I would also like to refer you to slide two of the conference call presentation for further information. With that, I’ll turn the call over to Astrana Health President and Chief Executive Officer, Brandon Sim. Please go ahead, Brandon.

Brandon Sim: Thank you, operator. Good evening and thank you all for joining us today. We began 2024 with a strong first quarter here at Astrana Health because we expand our innovative care model and technology platform to empower entrepreneurial providers and improve health care and local communities throughout the country. We continue to deliver against our strategic roadmap and are proud to announce compelling, financial, operational and clinical results to start the year. I’ll start by highlighting our financial performance for the first quarter of 2024. Total revenue at Astrana reached $404 million, a 20% increase compared to the prior year period. And adjusted EBITDA rose to $42.2 million, up 42% compared to the prior year period.

This resulted in an adjusted EBITDA margin of 10.4%. Both growth and profitability metrics were driven by robust membership growth across all our lines of business, coupled with ongoing success in managing the total cost of care for these members and value-based risk-bearing arrangements. We also continued investing in our teams, our technology platform and our new market entry operations. We believe these investments are critical towards our ongoing commitment to building a sustainable business even as we continue to expand rapidly. As a reminder, we’ve consistently talked about the four pillars of our business which we feel our platform is uniquely positioned to execute on. One, expanding our membership base across existing and new geographies, two, increasing the level of accountability and risk we are responsible for our value-based care contracts, three, empowering our providers to achieve superior patient outcomes and four, executing strategic acquisitions to further accelerate our growth trajectory.

On the first pillar, we experienced robust growth in membership in both core and new regions. We now manage approximately one million lives driven by robust organic growth and strategic acquisitions. Our membership grew organically by around 10% year-to-date a number that is net of Medicaid redetermination and does not include a new strategic acquisition. On the second pillar, we continue to take on greater responsibility for the total cost of care of our members, as we promised we would do as. Of April 1, our full-risk business makes up approximately 60% of total capitation revenue and we anticipate continuing to grow that percentage, while consistently delivering high-quality care as the year progresses. In addition, we also began taking on full risk delegation in the state of Nevada.

We believe that we are uniquely positioned to capture the embedded growth that this pillar represents because of the high level of visibility and consistency that our proprietary technology and clinical infrastructure affords us. I’d like to continue emphasizing the key aspect of our business that distinguishes Astrana Health from other providers and peers. We have always committed to serving all segments of our communities in value-based care arrangements, covering all payer types from original Medicare, Medicare Advantage, managed Medicaid to commercial. And we continue to forge ahead in our transition to risk and being truly accountable for our members whole health across those diverse business segments, even as others have shied away. The infrastructure, technology and team that we have built allows us to do as well results in our ability to serve a wider patient population, make our providers lives simpler and more efficient, diversify our business and better manage risk and support our payer partners across their entire business With regards to the third pillar of our business, Astrana is focused on providing high-quality care and access to all members.

We have noted continued outperformance compared to historical years in terms of Helios ACC and other quality-related outcomes. We also continue to focus on making sure members receive the right care in the right setting leading to our continued strong performance on clinical utilization metrics. Our bed days per thousand and admits per thousand improved in the first quarter when compared to previous periods. This improvement is consistent across all business segments with Medicare, Medicaid and commercial authorizations for inpatient and outpatient services, mirroring this trend. Moving on to the fourth pillar of the business strategic acquisitions. We successfully closed the second and final part of our community Family Care acquisition this quarter, as we had previously guided.

This acquisition marks the largest in Astrana’s history and serves as a successful example of a care enablement client, deepening its relationship with Astrana Health and moving into the care partner segment. The integration of CSC was seamless as we were already powering the CSC business, with our care enablement platform prior to the acquisition, showcasing the value and synergy of leveraging our care enablement tech-enabled services business. The completion of this transaction allows us to take on greater responsibility for the outcomes of the patients we serve, with CSC’s full risk Medicaid, restricted Knox-Keene licensed. It also further strengthens our commitment to managing medical costs, and providing quality care in our communities.

Looking ahead, we expect to transition the majority of our Medicaid members to full-risk arrangements in the next six to 12 months. This quarter, we also completed the acquisition of Prime Community Care of Central Valley or PCCCV. A risk-bearing provider organization with over 150 primary care and multi-specialty care providers, which serve around 26,000 primarily Medicaid members in the Central Valley of California. Prior to this, our organic growth and partnership efforts in the Central Valley had been robust and PCCCV joining our care partners’ business will be a further accelerant, for our efforts to deliver high-quality high-value care to communities in the Central Valley and also represents our entry into San Joaquin County. Over the next 12 months, we anticipate continuing our strategy in the region with PCCCV in the fold, taking greater accountability for total cost of care for these members and further integrating with our care enablement platform, in order to advance patient outcomes and empower community providers in the region.

And outside of California, we continue to see a rich pipeline of both organic and inorganic opportunities in both Texas and Nevada and beyond. We believe that the strong growth and consistent execution of our strategic road map demonstrate the uniqueness of our platform for care model and technology capabilities, are well established value-based infrastructure and long track record of managing total cost of care and patient outcomes, in value-based arrangements across all payer types, with confidence in the ongoing growth and profitability of our platform. To conclude my prepared remarks, I want to express my gratitude to our teammates, providers and partners for their belief in our vision to transform health care and local communities nationwide.

The rapid growth and positive outcomes of the business would not be possible without your passion, dedication and support. With that, I’ll hand it over to Chan to review our financial results.

Chan Basho: Thank you, Brandon. Moving into this quarter’s performance, we began 2024 with total revenue of $404 million, a 20% increase from $337 million in the prior year quarter. This was primarily driven by increased competition revenue resulting from organic membership growth in our core IPAs, as well as the addition of CFC IPA on January 31st 2024. Care partners’ revenue increased 26% to $397 million during the period Along with the organic and strategic growth partners revenue increased due to the conversion and addition full-risk Membership. As of April first 2024, we expect our full risk business to account for approximately 60% of capitated revenues relative to 49% as of January first 2024. Adjusted EBITDA was $42.2 million, up 42% from $29.8 million in the prior year period.

In the first quarter of 2024, adjusted EBITDA excluded certain one-time items including a $4.7 million expense, related to a financial guaranty via a letter of credit that we provided two years ago, in support of two independently operated local provider led ACOs. Despite the removal of these ACOs from the CMS program. The shared losses for that year were recorded and we’re working with those two providers to recoup the funds that were spent. As I mentioned, this is not a recurring item nor do we believe it reflects the operations of our ACO business. Net income attributable to a strong health was $14.8 million an increase of 13% from $13.1 million in the prior year quarter. Earnings per share on a diluted basis were $0.31 up 11% from $0.28 in the prior year.

Now turning to the balance sheet. Our financial position remains well capitalized with $335 million in cash and cash equivalents and total debt of $393 million as of Q1 2024. This compares to $294 million in cash and cash equivalents and total debt of $282 million at the end of 2023. We are steadfast in our ability to execute our growth strategy by expanding our membership through both organic means and strategic acquisitions as well as transitioning our contracts to full risk. Further, we remain confident that full year projections align with expectations given our diverse payer mix and ability to manage cost of care as a result we are reaffirming our full year guidance for revenue, adjusted EBITDA and earnings per share. Looking ahead to the coming quarters, the successful completion of the second part of the CFC acquisition is projected to contribute a single digit uplift in Q2 revenue relative to Q1.

This will be reflected in the full quarter’s impact of CFC on our financials. Historically, Q3 has been our strongest quarter in terms of profitability, due to sweeps and ACO related payments. Our sustained participation in the ACO program has enhanced our capabilities around real-time data gathering and forecasting, due to the enhanced clarity, we are comfortable this year booking ACO earnings based on the quarter of their contribution. As a result, Q3 will be slightly lower in terms of EBITDA contribution percentage versus historical years. In closing, we’re extremely pleased with our performance in the first quarter, which has set a positive tone for the remainder of the year. Our strong organic membership growth strategic acquisitions of CFC and PCCCV, ongoing transition to full risk arrangements and the stability and improvements of our utilization metrics represent strong momentum for our business.

We have confidence in our ability to continue our long track record of successful execution. We will continue in our commitment to deliver the utmost quality of care to focus on industry leading patient outcomes and to serve more communities across the country. Thank you for your time today. With that, operator, we’ll turn to questions.

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Q&A Session

Operator: Thank you. Ladies and gentlemen, the floor is now open for questions. [Operator Instructions] And we’ll take our first question from Ryan Daniels from William Blair. Please go ahead.

Ryan Daniels: Hey, guys. Thanks for taking the questions. I’m curious if you could speak a little bit more to your pipeline either for new partnerships or M&A especially as we contrast your strong performance versus what some other peers are seeing in the market meaning is that opening up some opportunities? Is there pressure with provider groups to get new partnerships et cetera? Just any color there would be great.

Brandon Sim: Hey, Ryan, thank you so much for the — for the questions and for tuning in. And I think we’re seeing a very strong partnership and corporate development pipeline as we speak. And as you mentioned there is a huge desire especially given cost pressures margin pressures utilization trends that some of our peers are seeing and to find a partner that is going to be stable and present a long-term opportunity to provide value back to providers and ultimately back to the patients and so on. I think we’re absolutely seeing a strong pipeline, I think and there was an acquisition that we announced joining our care partner segment this quarter and the close of the CFC transaction. And I believe we are still planning to fulfill our guidance of at least one or two new markets per year as the year progresses here.

Ryan Daniels: Okay. That’s helpful color. And then just my follow-up on good new data on the total cap revenue being at 60% up from 49% in January. I guess, my question is now that you have both the Medicare and Medicaid RKK. How might we see that trend kind of towards year end? So where might you end the year in 2024? And then what would your goals be for 2025 and 2026 as I know that’s a nice kind of revenue and really a care management accelerator as well. Thanks and congrats on the strong performance.

Chan Basho: Thanks, Ryan. In terms of our year-end target, as we’ve discussed before we still expect to be at about two-thirds by year end, in our transition to full risk as we work through 2025, we see us continuing to move our membership into a full risk arrangement, and we do believe we will be able to get the majority of our contracts into full risk by the end of 2025.

Ryan Daniels: Great. Thank you so much. I’ll hop back in the queue.

Brandon Sim: Thanks, Ryan.

Operator: Thank you. And we’ll take our next question from David Larsen from BTIG. Please go ahead, David.

David Larsen: Hi. Congratulations on the quarter. I was positively surprised at the EBITDA. Can you maybe just talk about claims trend, how that’s tracking for your book of business? Some of your peers were hearing sustained high MA utilization, fairly high single-digit claims cost trend. What are you seeing? How did your cost trend come in relative to your own expectations? And I guess, what is your secret sauce? Why is your trend perhaps better than others?

Chan Basho: Hi, David. Great to hear from you. Thanks so much for the question. In terms of how we’re looking at utilization, first in terms of flu, we saw an equivalent to maybe a higher amount of flu cases, but a lower level of acuity. In terms of overall claims trend, as you know, because we do have full visibility around our utilization management and care management capabilities, which leads to us having visibility around authorizations, we are able to have a clearer sense around MCR. And we see across the board positive trends there, as Brandon mentioned during the call. We see some areas where, for example, due to regulatory reasons, genetic testing is now included in certain Medicaid-related cases, so we see an increase there. No real, but beyond that, we continue to see MCRs that are consistent or favorable relative to historical periods.

David Larsen: Okay. Can you put a percent number on your per member per month trend line? Is it below 5%? Is it between 5% and 10%? Below 3%? Any number you can put on that?

Brandon Sim: Hey, Dave. Thanks for the question. This is Brandon. I don’t think we’ve disclosed the exact trend line, especially because it differs by line of business. I would say that across all lines of business, Medicare, commercial and MA, I would say it’s coming in a few percent lower than we had anticipated at the beginning of the year or prior to this year, prior to this quarter. It is still early in the year, I would say, so we’re here in May, and we, out of conservatism, reaffirm guidance, but I do think early results starting up the year here are promising.

David Larsen: Okay. And then can you maybe talk a little bit about your approach to managing inpatient services? I mean, it’s my understanding that you actually have a strand of hospitalists that manage care to an extent within inpatient facilities. So should we be worried about a spike in claims costs for hospitals once you start sort of bearing more full risk?

Brandon Sim: There definitely will be higher claims costs, obviously offset by higher claims, higher capitation revenue as we continue to move into full risk. And we’re starting to see that already as we get to around 60% of our capitated revenue in full risk arrangements. However, we don’t — while that may be a temporary pressure to overall EBITDA margin, as we’ve formally discussed, from a raw EBITDA number perspective, it’s still accretive, certainly, and we think we’re well prepared to take on the full risk and maintain medical margins where we would like them to be because of the ability we have in terms of our hospitalists working at the hospitals, in terms of our post-discharge care teams taking care of folks after an inpatient visit, and in terms of our deep specialist and primary care provider integration for patients across the care’s continuum spectrum.

Even as we grow into new markets, we’re seeing — we’re able to contract effectively with hospitals and replicate some of the elements that we used in California to successfully manage cost of care in both outpatient and inpatient settings. So that’s something we continue to keep in mind, for example, as we enter full risk delegated contracts here in Nevada, or in Texas, or beyond.

David Larsen: Okay. That’s great, very helpful. Thanks very much. And then, just last one, like CFC integration, how is that progressing? Just any thoughts or color there would be very helpful.

Brandon Sim: Sure, thanks. Yeah, CFC integration, as I mentioned, the prepared comments are going very well. And we’ve of all the providers are now already are already on our care and in one platform obviously given that it is powered CSC even prior to acquisition and from a regulatory standpoint things have been settled leading to the successful close of March 31, the second part of the CST transaction and throughout the remainder of the year most of the CST members already in forward contracts dating back to the middle of 2023. And there are additional synergies with our existing business that we look to capitalize on for the remainder of the year.

David Larsen: Okay. Congratulations on a great quarter. I’ll hop back in the queue now.

Brandon Sim: Thanks so much, Dave.

Operator: Thank you. And we’ll take our next question from Adam Ron from Bank of America. Please go ahead, Adam.

Adam Ron: Hey, a super quick one. So the 60% number that you’re talking about for capitation that you’re using I want to make sure I understand it. So you’re saying for 60% of what you’re reporting as capitation revenue that number that you’re reporting is some capitation rate let’s call it 85% of whatever the benchmark that we are managing is. And if that’s true that I’m understanding that correctly on the remaining 40% what is roughly the capitation rate that you’re doing today and connect with 85% to that could you give us like a sense of like what the dollar opportunity and revenue is from here? Thanks.

Brandon Sim: Hey Adam thank you for the question executed and you’re absolutely correct. In your understanding 60% of the capitated revenue that we report in the care partner segment comes from an arrangement in which call it approximately 85% of the premium dollar is being given to us in a capitated value-based arrangement. Another 40% of the dollars, I would say that those are mostly coming from arrangements in which we have outpatient risk only which would be illustratively call it around 35% to 40% of the premium dollar. So there is additional opportunity. We anticipate capturing some of it over the remainder of this year or some of it into 2025 in terms of converting some of those contracts into forest in our 85 approximately percent of premium contracts.

Adam Ron: Okay. No that’s perfect. And then in terms of the MLRB. seems pretty significant to your 0.7 month trend was a couple of percentage lower than what you thought it was worth on a 10% margin business is pretty substantial. So Tom? Yes. Just curious one why you didn’t raise the guidance and to what — what are the big factors versus expectations that are that are coming in different? And the three somewhat unrelated. But in the 2025 rate notice one of the surprising aspects was in Los Angeles the rate for growth rate of trend was 5% while the rest of the industry got like 2.4 something. And so curious if like CMS’s view of what’s happening in LA County is different from yours where potentially they’re saying trend is accelerating? And then on the other hand into 2025 is that a tailwind for you? Or is it entirely offset by what the payers are doing with benefits. Thanks. Appreciate that – answer multifaceted question.

Brandon Sim: Yes. Of course. I kind of one at that time Adam so on the — and it on the well I just want to clarify my prior response to 60% of our capitated revenue that’s for risk as of April 1. The day after the end of the quarter you’re right time right after the close of this meeting that making that clear. In terms of kind of the utilization trends that we’re seeing as John mentioned today I talked about I’ll give a little more color. We are encouraged, cautiously optimistic about the trends we’re seeing in terms of utilization. We are seeing kind of broad-based support for the increase or the decreases rather utilization trend across different lines of business different pockets of the business. There are a couple of pockets that John mentioned earlier for example that are maybe higher than expected.

But overall the trend is very positive. And I would say that the reason for not increasing guidance at this point in time it’s early in the year Adam I think we again cautiously optimistic, but I think we and we probably still fall within the range. There is increased because there’s a bit of increased investment in the teams and new market entry and we think are we’re on track and we’ll provide more updates as the year progresses. In terms of the question on Los Angeles MA benchmarks and overall I would say we were fairly disappointed as others work with the MA rate notice to final notice. And I think the as you mentioned the LA benchmark came in a little higher than and maybe we had thought or compared to other regions that we think that could be a tailwind for sure.

But that’s again it’s still early in the year. We’re still negotiating and talking to payers working with our partners around some of the benefits that will take place in 25 how the plant will be designed do all of this will holistically probably be and what will go into the final kind of economics and we anticipate becoming somewhat further guidance on that to you in the coming.

Adam Ron: Okay. Thank you. Thanks.

Brandon Sim : Thanks, Adam.

Operator: Thank you. [Operator Instructions] And we will take our next question from Jack Slevin from Jefferies. Please go ahead, Jack.

Jack Slevin: Hey thanks for taking the question and congrats on the quarter. I wanted to do a bit of a double-click on the Nevada contract. Can you give a little more color on maybe what payer class that that risk contract represents and down sort of what you’re seeing that made you want to flip that on immediately and have at or if sort of the infrastructure and the March entry costs have been building up over the last year. Are there and ready to hit the ground running on it?

Brandon Sim: Hey, Jack thanks for the question. Yeah, so in Nevda, we finished some shared risk arrangements or partial risk arrangements for about a year, maybe a little more than a year at this point. And the full-risk contract that we turned on was the Medicare Advantage contracts, and it’s one in which we actually have delegated payer responsibilities. So we utilization management, care management, claims, credentialing and contracting et cetera, which very much look similar to the infrastructure we built in California. We felt comfortable turning it on after looking at some of the results while participating under a shared risk arrangement, as well as the confidence in the infrastructure. We’ve now built into that over the last call it 12 to 18 months. And so that’s something that while still fairly small book of business relatively speaking and we’re excited to continue to prove that the model scales outside of some of our core regions.

Jack Slevin: Got it. Thanks for the color there. And then just on the chorus transition a lot of moving pieces that we’re hearing from MA plans in particular but sort of on cost trend broadly just thinking about I know you guys have a lot of visibility into the opportunity there given the role that you play currently. But as you think about adding in patient risks throughout a lot of you know probably what is the California base in a how are you measuring up sort of moving pieces with cost trends that are underlying and move that plans might be making on how they bid into next year when factoring in how you do transition those lives? Is it still just push on as quickly as you can, or do you have to be a little more selective given the environment?

Chandan Basho: So Jack in terms of our contracts, I don’t want you to think we’re moving contracts over actuarially post analyses. It doesn’t make sense for us to do so. So we are looking at our claims trend. We are looking at overall medical trend. We are looking at the unique capabilities we can bring to that market in terms of our medical management capabilities, our care management capabilities and the technology that we can offer in that local marketplace. And as that links together and in many markets we have it amount of risk already. We will then move forward in a very prudent fashion.