Astrana Health, Inc. (Astrana) operates as a provider-centric, technology-powered, risk-bearing healthcare company.
Leveraging the company’s 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 accessible, high-quality care to patients in a cost-effective manner. The company, together with its affiliated physician groups and con...
Astrana Health, Inc. (Astrana) operates as a provider-centric, technology-powered, risk-bearing healthcare company.
Leveraging the company’s 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 accessible, high-quality care to patients in a cost-effective manner. The company, together with its affiliated physician groups and consolidated entities, provides coordinated outcomes-based medical care serving patients in California, Nevada, Texas, Maryland, Connecticut, Georgia, and Hawaii, the majority of whom are covered by private or public insurance provided through Medicare, Medicaid, and health maintenance organizations (‘HMOs’), with a small portion of its revenue coming from non-insured patients. The company provides care coordination services to each major constituent of the healthcare delivery system, including patients, families, primary care physicians, specialists, acute care hospitals, alternative sites of inpatient care, physician groups, and health plans. The company’s physician network consists of primary care physicians, specialist physicians, physician and specialist extenders, and hospitalists.
Through the company’s integrated health network of more than 10,000 contracted physicians, it was responsible for coordinating value-based care for approximately 1.1 million patients as of December 31, 2024.
Segments
The company implements and operates different innovative healthcare models, primarily including the following three reportable segments: Care Partners, Care Delivery, and Care Enablement.
Care Partners
The company’s Care Partners segment is focused on building and managing high-quality and high-performance provider networks by partnering with, empowering, and investing in strong provider partners. Astrana meets providers where they are and enables independent providers to remain independent while succeeding in value-based care. The company acts as a ‘single payer’ for its network of providers, enabling value-based care arrangements, including hospital shared-risk contracts. By leveraging the company’s unique Care Enablement platform and ability to recruit, empower, and incentivize physicians to manage total cost of care effectively, it is able to organize partnered providers into successful multi-payer risk-bearing organizations that take on varying levels of risk based on total cost of care across membership in all lines of business, including Medicare fee-for-service (‘FFS’), Medicare Advantage, Medicaid, Commercial, and Exchange. Through the company’s network of risk-bearing organizations (‘RBOs’) that encompass independent practice associations (‘IPAs’), accountable care organizations (‘ACOs’), and state-specific entities, such as Restricted Knox-Keene licensed health plans in California, the company’s healthcare delivery entities are tasked with the coordination and provision of high-quality care to patients within Astrana’s ecosystem. This helps provide seamless continuity of care among patients in different age groups, stages of life, and life circumstances.
An IPA is an association of independent physicians, or another organization that contracts with independent physicians. IPAs provide services to HMOs, which are medical insurance groups that provide health services generally for a fixed annual fee, on a negotiated per capita rate, flat retainer fee, or negotiated FFS basis. The company’s affiliated IPAs comprise a network of independent primary care physicians and specialists who collectively care for patients. The company’s IPAs contract with various HMOs and other licensed healthcare service plans, such as Restricted Knox-Keene licensed health plans, as defined in the California Knox-Keene Health Care Service Plan Act of 1975, as amended (the ‘Knox-Keene Act’), to provide physician services to their enrollees, typically under capitated arrangements. Each HMO negotiates a fixed amount per member per month (‘PMPM’) that is to be paid to its IPAs. In return, the IPAs arrange for the delivery of healthcare services by contracting with physicians or professional medical corporations for primary care and specialty care services.
An Accountable Care Organization, or ACO, participates in one or more payment and delivery models sponsored by the Centers for Medicare & Medicaid Services (‘CMS’) that provide high-quality and affordable care to Medicare Fee-For-Service patients. The CMS programs allow provider groups to assume higher levels of financial risk and potentially achieve a higher reward from participation in the respective program’s attribution-based risk-sharing model. For the year ended December 31, 2024, the company’s ACOs participated in the ACO REACH Model and the Medicare Shared Savings Program (‘MSSP’).
Care Delivery
The company’s Care Delivery segment is a patient-centric, data-driven Care Delivery organization focused on delivering high-quality and accessible care to all patients that sees approximately 800,000 patients annually. As medical care has been increasingly delivered in clinic settings, many integrated health networks also operate healthcare facilities primarily focused on the diagnosis and/or care of outpatients, including those with chronic conditions, such as heart disease and diabetes, to cover the primary healthcare needs of local communities. The company’s Care Delivery organization spans over 60 locations across three states and includes: Primary care clinics, including post-acute care services; Specialty care clinics and inpatient services, including cardiac care, endocrinology, and ophthalmology, as well as hospitalist and intensivist services; and Ancillary service providers, such as urgent care centers, outpatient imaging centers, ambulatory surgery centers, and full-service labs.
The company evaluates its Care Partners networks based on specialty and geographic location, and then strategically builds or acquires practices and provider groups to address any gaps. This ensures that patients have access to high-quality care. The company’s ability to establish Care Delivery clinics tailored to specific markets enables it to scale effectively as it enters into new markets.
Care Enablement
The company’s Care Enablement segment represents a comprehensive platform that integrates clinical, operational, financial, and administrative information, all powered by its proprietary technology suite and underpinned by more than 35 years of real-world data. This platform enhances the delivery of high-quality, value-based care to its patients and helps lead to superior clinical and financial outcomes. The company’s Care Enablement tools are leveraged across its Care Partners and Care Delivery lines of business, as well as third-party providers outside of its Astrana ecosystem. The company’s Care Enablement segment provides solutions to payers and providers, including independent physicians, provider and medical groups, and ACOs. The company’s platform meets providers and payers wherever they are on the spectrum of total cost of care, offering solutions for FFS entities to providers open to taking upside and downside risks on professional and institutional spending, and across all patient types, including Medicare, Medicaid, Commercial, and Exchange-insured patients.
Population health management (‘PHM’) is a central trend within healthcare delivery, which includes the aggregation of patient data across multiple health information technology resources, the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve both clinical and financial outcomes. PHM seeks to improve health outcomes by monitoring and identifying individual patients, aggregating data, and providing a comprehensive clinical picture of each patient. Providers can use that data to track and hopefully improve clinical outcomes while lowering costs. A successful PHM platform requires a robust care and risk management infrastructure, a cohesive delivery system, and a well-managed partnership network.
The company’s Care Enablement segment includes management service organizations (‘MSOs’) that provide non-medical services under management service agreements (‘MSAs’). Under these arrangements, the MSOs have authority over various non-medical decisions related to ongoing business operations. These services include, but are not limited to: Physician recruiting; Physician and health plan contracting; Care management, including utilization management, medical management, and quality management; Provider relations; Member services, including annual wellness evaluations; Claims processing; Pre-negotiating contracts with specialists, labs, imaging centers, nursing homes, and other vendors; and Revenue cycle management.
Integrated Health Network
An integrated health network that is able to pool a large number of patients, such as the company and its affiliated physician groups, is positioned to take advantage of industry trends, meet patient and government demands, and benefit from cost advantages resulting from its scale of operation and integrated approach of care delivery.
Through the company’s RBOs with over 10,000 contracted healthcare providers, which have agreements with various health plans, hospitals, and other HMOs, it was responsible for coordinating the care of approximately 1.1 million patients as of December 31, 2024. These patients consist of managed care members whose health coverage is provided through their employers, or who have acquired health coverage directly from a health plan or as a result of their eligibility for Medicaid or Medicare benefits. The company’s managed patients benefit from an integrated approach that places physicians at the center of patient care and utilizes sophisticated risk management techniques and clinical protocols to provide high-quality, cost-effective care. To implement a patient-centered, physician-centric experience, the company also has other integrated and synergistic operations, including MSOs that provide management and other services to the company’s affiliated IPAs, primary care clinics, multi-specialty care clinics and medical groups, and ancillary service providers.
Key Payers
A limited number of payers represent a significant portion of the company’s net revenue. For the year ended December 31, 2024, four payers accounted for an aggregate of 66.2% of its total net revenue.
Competition
IPAs
The company’s affiliated IPAs compete with other IPAs, medical groups, and hospitals, many of which have greater finances, personnel, and other resources. In the greater Los Angeles area, such competitors include Regal Medical Group and Lakeside Medical Group, which are part of Heritage Provider Network (‘Heritage’), as well as Optum, a subsidiary of UnitedHealth Group.
ACOs
The company’s ACOs compete with other sophisticated provider groups creating, administrating, and managing ACOs, many of which have greater financial, personnel, and other resources available to them. Major competitors of the company’s ACOs include Privia Health and Aledade.
Outpatient Clinics
The company’s outpatient clinics compete with large ambulatory surgery centers and/or diagnostic centers, such as RadNet and Envision Healthcare, many of which have greater financial, personnel, and other resources, as well as smaller clinics with ties to local communities. Optum (f/k/a HealthCare Partners) also has its own urgent care centers, clinics, and diagnostic centers.
MSOs
The company’s MSOs compete with other MSOs in providing management, administrative, and other support services. One of such competitors includes Conifer Health Solutions.
Regulatory Matters
As a healthcare company, the company’s operations and relationships with healthcare providers, such as hospitals, other healthcare facilities, and healthcare professionals, are subject to extensive and increasing regulation by numerous federal, state, and local government agencies, including the Office of Inspector General, the Department of Justice, CMS, and various state authorities.
The privacy regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), as amended, contain detailed requirements concerning the use and disclosure of individually identifiable patient health information (‘PHI’) by entities like the company’s MSOs and affiliated IPAs and medical groups.
Federal regulations promulgated by the Occupational Safety and Health Administration impose additional requirements on the company, including those protecting employees from exposure to elements, such as blood-borne pathogens.
History
The company, a Delaware corporation, was founded in 1994. The company was formerly known as Apollo Medical Holdings, Inc. and changed its name to Astrana Health, Inc. in February 2024.