ASTH

We rate Astrana Health, Inc. (ASTH) as Avoid with a composite score of 36.2/100 at a current price of $19.23. The stock falls in the bottom quintile of our universe across key quantitative factors, and the multi-factor weakness suggests a high probability of continued underperformance.

The rating is primarily driven by strength in stability (47th percentile) and value (44th percentile), which together account for the majority of the composite score. Offsetting weakness in investment (20th percentile) and quality (35th percentile) tempers our overall conviction. We assign a No Moat rating (33/100), High uncertainty, and Poor capital allocation.

Key items to watch: momentum to confirm whether the current price trend has legs; balance sheet deleveraging progress; sustainability of the current growth rate. Any material change in these dynamics could warrant a reassessment of our rating. The moat trend is stable, which suggests the competitive landscape is stable for now.

Astrana Health, Inc. holds a top-quartile position (#0 of 50) within the Services sector, based on our composite quantitative scoring across quality, value, momentum, and stability factors. The composite score of 36.2/100 places it at rank #3994 in our full 7,333-stock universe. At $1.6B in market capitalization, Astrana Health, Inc. is a small-cap player in the Services space, which limits certain scale advantages but may allow for more agile strategic execution.

Revenue is growing at 97%, though momentum at the 38th percentile suggests the market has not yet fully recognized this trajectory. This potential disconnect between fundamental improvement and market recognition could represent an opportunity for patient investors if the growth trend persists.

The margin cascade tells an important story: gross margins of 10% (-49.6pp vs sector) narrow to operating margins of 4% (+0.1pp vs sector) and net margins of 1.7%, yielding a gross-to-net conversion rate of 17%. This conversion rate is typical for the sector, suggesting a standard cost structure without notable efficiency advantages or disadvantages.

At a current price of $19.23, Astrana Health, Inc. is trading near fair value based on current fundamentals. Our value factor score of 44/100 reflects a composite assessment across multiple valuation metrics including price-to-earnings, price-to-book, EV/EBITDA, and price-to-sales ratios relative to both sector peers and the broader market. Valuation metrics are mixed, with no strong signal of mispricing in either direction.

The stock currently trades at a P/E of 27.3x (roughly in line with the sector median of 23.7x), EV/EBITDA of 11.3x (near the sector median), P/B of 1.3x, P/S of 0.4x. The above-sector P/E multiple suggests the market is pricing in superior growth or quality, which our analysis finds only partially justified by current fundamentals.

We assign a High uncertainty rating to Astrana Health, Inc.. Key risk factors include significant leverage (213% debt-to-equity), low beta of 0.47 — while defensive, this may indicate limited upside participation in bull markets, the combination of leverage (213% D/E) and thin margins (1.7% net) amplifies downside risk. The wide range of potential outcomes widens our fair value estimate and increases the possibility of permanent capital impairment. Investors considering this name should size positions accordingly and demand a meaningful margin of safety before initiating.

Specific risk factors that inform our assessment include: significant leverage (213% debt-to-equity); low beta of 0.47 — while defensive, this may indicate limited upside participation in bull markets; the combination of leverage (213% D/E) and thin margins (1.7% net) amplifies downside risk. Each of these factors independently widens the distribution of potential outcomes, and in combination they create a risk profile that demands careful position sizing. The stability factor at the 47th percentile and quality factor at the 35th percentile provide a quantitative summary of the overall risk landscape.

We identify limited risk mitigants at this time, which contributes to our high uncertainty assessment. Investors should monitor for improvement in balance sheet metrics, margin stability, and business predictability that could warrant a downgrade in our risk assessment over time.

We rate Astrana Health, Inc.'s capital allocation as Poor. Key concerns include low returns on equity (4.6%), elevated leverage (213% D/E), weak asset returns (ROA 1.6%). Exemplary capital allocators generate ROE above 20% and maintain conservative leverage — Astrana Health, Inc. significantly underperforms these benchmarks, raising questions about management's ability to create shareholder value.

Investors should scrutinize management's reinvestment decisions and balance sheet trajectory before committing capital. Poor capital allocation often compounds over time: overlevered balance sheets limit strategic flexibility, while low returns on capital destroy shareholder value. We would need to see sustained improvement in profitability metrics and balance sheet discipline before considering an upgrade.

In summary, Astrana Health, Inc. receives a Avoid rating with a composite score of 36.2/100 (rank #3994 of 7,333). Our quantitative framework assigns a No Moat (33/100, trend: stable), High uncertainty, and Poor capital allocation. The average factor score across quality, value, momentum, stability, and investment is 37/100.

Our analysis does not support a constructive view on Astrana Health, Inc. at this time. The combination of limited competitive advantages, high uncertainty, and poor capital allocation suggests unfavorable risk-reward at current levels. We recommend investors avoid new positions and existing holders consider reducing exposure.