Presentation. For those of you whom I've not yet met, my name is Ryan Daniels. I'm the Healthcare Services and HCIT analyst here at William Blair. It's my great pleasure to introduce Brandon Sim. Brandon is the President and CEO of Astrana Health. A couple of quick housekeeping items before we get started. First, our breakout session will be in Burnham B, up on the second floor. We'll go there immediately after for the Q&A session. Also, I'm required to inform everyone that our disclosures are available on our website at williamblair.com. Again, really happy to have Brandon here with us today. I think this is a great opportunity to be taking a look at Astrana. It's a really interesting company. I've spent a lot of time in the value-based care space over the last five or six years.
Astrana has been a company that's somewhat of a zig when others have zag. They were cautious with capital deployment when there was a lot of M&A activity. If we turn the page forward, others have now seen utilization pressures. They've been losing a lot of money. They've been reducing risk, and they've been kind of focusing on internal operations. Astrana, again, has been the exact opposite. They've controlled costs effectively. They've improved the quality of care, highly profitable, taken on more risk, and actually started to deploy capital effectively. I think it's a really interesting story that's underappreciated by the market. Again, very excited, therefore, to have Brandon here with us to tell all you a little bit more about it and why it's such a good opportunity. With that, I'm going to turn the microphone over.
Again, I'll just remind everyone that Burnham B for the breakout session immediately following this. Thank you.
Thanks, Ryan. Appreciate it. It's very nice to be here.
Hi, everyone. All right. Thank you very much, Ryan, for the very kind introduction. I'm very happy to be here back in Chicago and very grateful to William Blair for having us. Thank you so much. Thanks to all of you for attending today. Happy to just share a little bit about Astrana, what our vision is for how healthcare should work in this country to make it actually work for each patient, regardless of their insurance status, age, employment status, et cetera. I think we have a really unique model that's poised to grow not only in the next couple of years with a couple of tailwinds that I'll go over, but also for decades to come. Of course, standard forward-looking statements, so on and so forth.
At the end of the day, the reason that we exist is because we believe that the status quo for healthcare in America is broken. The current system where insurance companies control how healthcare delivery networks are created, when they control how prior auths are approved or denied, the way that they control how claims are paid and how and when they're paid, if they're paid at all, we believe is insufficient, poor, and limited for the American people. It is causing inefficiencies in the system in terms of how much it costs to actually provide care to Americans. It causes poor patient satisfaction, poor patient outcomes, as well as poor provider satisfaction. It is burning our physicians out at an unprecedented rate. It really continues to lag behind other industries in terms of the level of technology, AI, and coordination that exists in the system today.
Even though America is a beacon of progress in terms of technology, we probably have all felt in this room how poorly coordinated and how backwards in terms of technology our provider practices can be. The point of this graphic here is not to show necessarily for you to follow where all the arrows go, but to show that there are too many darn arrows on this map. There should not be so many different connection points with each insurance company trying to build its own network, each insurance company trying to perform its own prior authorizations, denying claims, coordinating care in a way that is not effective and is not working for the American people.
The reason we really exist, why we think that we've continued to exist for over 30 years, and why we continue to grow rapidly, over 50% year over year in Q1, our most recently reported earnings, is because we're changing what the status quo looks like in terms of what insurance companies do and how they provide care. Instead of each insurance company creating their own physician network downstream and all of us in this room logging on to our insurance websites and trying to figure out which doctors are in network or out of network, we are saying, let's get rid of all of that. Let's let Astrana Health, a third-party entity that is not owned by any insurance company, build one highly coordinated, very accessible, and high-quality physician, primary care physician specialist and hospital network.
Let's let all of the insurance companies use just that one network that we're going to make sure is going to deliver great outcomes, patient satisfaction, and work with the doctors in an intimate fashion. Instead of 20 different insurance companies, UnitedHealthcare, Humana, Aetna, Cigna, Molina Healthcare, Blue Cross Blue Shield, so on and so forth, all building their own networks, and all of us having to log on and figure out which doctor is in network or not, if I get a new job, is my existing PCP in network or not, why don't we just have one entity create the backbone, the infrastructure for healthcare delivery, and allow all the insurance companies to use that one network that's going to be more efficiently run than each insurance company trying to do it on their own? With recent news, insurance companies aren't even running their networks that well.
We can see that in terms of, and we'll go over some of the headwinds to the industry and why we're different in a bit. The model that we've created is really that we will go out, create physician networks downstream that's a mix of our own clinics that are branded Astrana Care, that we own and operate, brick and mortar, that's our care delivery system in the middle there, in combination with contracted physicians, over 12,000 of them that we partner with, in order to build a cohesive network that we then go and sell to payer partners.
When we go to the payer partners, what we tell them is, instead of you all trying to build your own systems, just give us a certain percentage of your revenue dollar, and in exchange, we will be responsible for not just providing care to your beneficiaries, but also performing the payer functions that insurance companies typically would do. For example, we would create the networks, we would credential the doctors, we would perform prior authorization for the patients when physicians submit those requests, we would pay the doctors their claims. Really, all the arrows that you're seeing in this prior slide where there's a many-to-many relationship between physicians and payers are collapsed down into one and a single payer, pseudo-single payer-like setting.
If I am a doctor that formerly was contracted with 20 different insurance companies, I might have to submit my prior auth request to 20 different companies, wait two or three days for my patients to get the approval or denial, oftentimes in the mail, and then the patient can start their journey of trying to get an appointment for the specialist they need that could take months. In that time, by the way, that patient could crash out, need to go to the emergency room, get hospitalized, causing an incremental burden to our system that is really unnecessary. In our system, all of the prior auth requests come straight to us as the single payer. Regardless of whether the patient is UnitedHealthcare, Aetna, Molina Healthcare, so on and so forth, the physician is submitting that prior auth request to Astrana.
We're approving that over 70% of the time completely automatically using AI, no denials via AI, by the way, just approvals. In that same visit, before you even walk out of the physician's office, you already know that your prior auth is approved. Our care teams are going in, because again, it's our network, one network, we're going to our specialist network, helping you get an appointment. Oftentimes our patients can see their specialist before they even go home that day. There is less risk of them having to crash out into the emergency room or into an unnecessary inpatient admission, costing the healthcare system tens of thousands, if not hundreds of thousands of dollars. That's what the model is.
It's that by centralizing the network building exercise to one place, instead of having each insurance company try to do their own, and they're all basically the same anyway, we're building what we believe to be the fabric of a more efficient healthcare system. It's almost as if the analogy would be for telecom companies. Instead of each T-Mobile and Verizon and AT&T all building their own satellite and towers networks to have coverage over the country, it's as if one company just built all the towers and just sold access rights to those towers to all of the telecom companies. That's what we believe we're doing for healthcare. We're building the infrastructure that will deliver efficient, high-quality, and accessible care to patients across all patient types, across all ages, across all geographies.
We're selling that to insurance companies in a way that we're doing it more efficiently than they are and taking a cut of the savings. On the right side of the slide here, you can see an example of the network density, sorry, the network density that we've built in one of our given regions in the San Gabriel Valley near Los Angeles, where we were founded. From that one market, we've moved and expanded into 13 different markets across four, five, six different states across the country. Not just California, the rest of California, but also Nevada, Texas, Connecticut, Georgia, and others.
We continue to build in each of the markets that we serve this critical density that is necessary in order to truly provide that coordinated, high-quality, accessible care that we talked about earlier and go to our payer partners and incredibly tell them with our network, you can actually serve all the patients, all your beneficiaries across Medicare, Medicaid, and commercial lines of insurance in a cost-effective and high-quality way. Our strategy overall, this reimagining of where networks should be built and who should be responsible for healthcare delivery, has proven to be a profitable and high-growth business model. Over the last six years that I have been at the company since 2019, we have grown at an almost 29% revenue CAGR. We have grown profitability at a 22% EBITDA CAGR. We serve over 1.1 million patients in recurring revenue contracts with over 12,000 physicians and providers on our platform.
Our LTM revenue is over $2 billion, and our LTM EBITDA is over $170 million. The business at the end of the day, even though I said a lot of words and the healthcare system is very, very complex, is actually quite simple. The waterfall in terms of how we make money is there are only three really large components to that waterfall. It is revenue that we are getting from our payer partners minus cost of goods sold, which is literally just how much we pay in terms of claims on behalf of actually providing care to our patients. Then it is the G&A load after that. If we can maximize revenue, if we can minimize cost of care, and if we can minimize G&A costs, that is the recipe to continued growth both in the top and the bottom lines.
For the next couple of minutes here, I'll walk you through how exactly we're increasing revenue, decreasing COGS, and decreasing G&A. It's a very simple formula. We believe that if we continue to do this formula, execute on this formula, we'll continue to grow at the 20% plus rates that we have over the last six years each and every year. First of all, the first two levers here are going to be about revenue growth. Revenue growth can be broken down into membership growth, that those 1.1 million members that I talked about earlier, and revenue per member growth on a unit economic level. First, on the membership growth side, there are two real ways that we're growing membership, both organically and inorganically. On the organic side, we're continuing to grow across our home state of California.
We continue to be headquartered in Los Angeles. As you can see here, back in 1992, launched in Southern California, grew into other counties in Southern California, such as San Bernardino and Riverside County, two of the top five largest counties in the United States, expanding into San Francisco and adjacent markets, Santa Clara, Alameda, so on and so forth, and then moving into the central agricultural valley of California and down to the Mexican border in San Diego. Over the years, we've continued to grow in California and prove that our model works not just in Los Angeles, but across the entire state in a profitable way.
Outside of California, we've continued to identify certain geographies that make sense from a demographic perspective, from a growth perspective, and where we believe that we can quickly make an impact in terms of turning markets into profitability by providing coordinated, high-quality care. Some of these states across the Sun Belt, for example, such as Nevada, neighboring to California on the east, and then Texas down in the south, are markets that we've entered more recently in order to continue to scale and prove that our model works in other states across the country. We believe that we have a pretty reliable playbook for moving from the initial investment it costs to enter a market, $5 million-$10 million of drag to P&L, to break even to profitability within a two to three-year timeframe. The playbook is really quite simple.
It's the exact same thing that we've done in California across many counties in California for the last 30 years. When we enter a new region, we start by building that core delivery network that we need to even sell to the payers in the first place. We use our technology platform, which I'll talk about a little bit later, to generate operational efficiencies. We take some of those savings and we reinvest the savings into patient care. Over time, as patients are healthier, because of some of the examples I gave earlier, driving down unnecessary utilization of expensive inpatient services, we take those dollars and we reinvest it into more patient care, which creates this kind of flywheel over time that allows us to become more profitable as we continue to grow and mature in a given market.
We're seeing that play out exactly as we expected in both Nevada and Texas. We entered Nevada at the end of 2022. Nevada is now a profitable market for us. Texas, a little bit behind in Q3 of 2023, around break even today and inflecting towards profitability very soon. Moving on to inorganic growth, we've seen a lot of opportunity, as Ryan mentioned at the very beginning before my presentation, in terms of growing our platform very rapidly because of the automation that we've generated or the automation that we've created in our technology platform and our unique care model. We found opportunities to acquire other businesses that are risk-bearing, that are provider businesses, onboard them onto our platform, integrate them, and quickly find increased revenue and EBITDA opportunities in the businesses that we acquire for a very attractive price.
We believe that these tuck-in and opportunistic acquisitions are a very good use of shareholder capital in terms of the IRR that we are seeing on the deals. One case study, for example, is a group called Community Family Care, a group in Southern California. Prior to us acquiring them, they were generating a certain amount of revenue, a certain amount of EBITDA. Over a three to four-year period, we not only helped them grow their revenue and EBITDA, but also found that it was opportunistic to just acquire our client. You can see the results here, more than doubled on both revenue and EBITDA. I think quintupled on the EBITDA side. The business continues to grow very profitably as a part of the Astrana network.
This is just one example of the inorganic growth that we've, again, opportunistically found ways to deploy capital as others have started struggling in recent times. There are two recent examples as well. We bought for $37.5 million the divested provider assets from Centene, the large health plan that was losing over $20 million a year in 2024. By onboarding them onto our technology platform, we've already gotten them to break even for the year, even though we just closed that deal in late October of last year. The large deal that's coming down the pipeline, again, opportunistic, is our planned acquisition of an entity called Prospect Health. Prospect Health is an entity that serves over 600,000 members in Southern California, enables over 14,000 doctors in Southern California, and really operates in a very similar business model in very adjacent counties to where we operate today.
They generate over a billion, too, of revenue and over $80 million of just EBITDA. We're acquiring this business. We're planning to acquire this business, rather, for $745 million. We think the deal will close sometime this summer. We are very excited to have the opportunity, just like we did with CFC, just like we did with the Centene asset, to integrate them onto our platform, start driving efficiency via our AI-enabled technology platform, start driving our care model into their patient base, and over time, use that flywheel to continue to generate profitability over and above that $81 million that we're buying for Prospect Health. We think because of our track record in doing this over and over again, both organically and inorganically, that we'll be able to integrate this asset in a very smooth fashion.
In fact, just yesterday, we announced that we have hired the former Chief Operating Officer of Prospect. She was the COO there for close to 10 years as our Chief Operating Officer of our MSO division. We are very excited to have Sherry on board. We think with Sherry's help, with our technology platform and care model and our clinical differentiation, that we will really turn Prospect into a very profitable asset or an even more profitable asset for years to come. Now, moving on to the second pillar of growth, which is revenue per member growth. Of course, we can grow the number of members that we are serving. On each member, we would also look to increase the amount of revenue that we are receiving for that member from our health plans, from our health plan partners.
Here you'll see, and I think it's a bit light, so I apologize, but here you'll see that over the last three years, we have worked to move more of our members into what we call full risk arrangements. What that really means is that we are taking on more and more responsibility in our agreements with the health plans in order to take on additional chunks of the health plan's revenue. Prior, in a partial risk arrangement, for example, we might only receive 35-40% of the revenue dollar that the health plan receives in terms of their premiums. We would be only responsible for outpatient-related costs. We would not be responsible for any hospital or inpatient-related costs related to that patient.
Prudently, over time, in areas that we believe that we can have an impact on the level of inpatient care, for example, areas where we have a lot of density, areas where the hospitals allow us to use our hospitalists around at the hospital and do discharges and work on the care plans and coordinate with the rest of the care teams, we are moving those members into arrangements where we are responsible not just for outpatient care, but also inpatient care. That allows us to go from around 35-40% of the premium dollar to taking on 85-90% of the premium dollar. To put that into context, for example, an average Medicare Advantage patient is reimbursed at around $1,000 per patient per month. Prior, we were getting $400, call it approximately, per patient per month.
In a full risk arrangement, we would move to around $850-$900 per patient per month. That is why you'll see that over the years, as we've driven the percentage of full risk members from 4% to around 38% in Q1 of 2025, that 38% of members actually drives 75% of our revenue in Q1 of 2025 because of the revenue per member delta in terms of partial to full risk. We believe that we can actually drive our percentage of full risk, increasing the revenue per member to around 70% of our patient mix. It's never going to be 100% because we want to be prudent about not entering into full levels of risk on the first couple of years that we are responsible for that patient. We want to get to know them. We want to implement our care plan.
We want to implement our clinical models for a couple of years before going to full risk. Once we feel comfortable, we feel that we can move a majority of our members into full risk arrangements and further drive revenue in that fashion. Combining those two levers, growing the number of members that we're responsible for in value-based contracts, and then increasing the revenue per member by moving them to a full risk arrangement, we believe that we can truly continue to drive strong revenue growth, almost 29% over the last six years, and continue to drive that in the years going forward. Moving on down the waterfall to cost of goods sold, which are really just the medical costs incurred by our patient base.
We believe that because of our unique care model and the unique business model, we are uniquely positioned to impact the long-term health of our patients. Part of the reason is that we serve as that single payer base for our patient population. You can imagine, for example, as many of you know, every year, a Medicare patient can choose to join a different insurance company during the annual enrollment period. They can choose to switch from one to another. They can choose based on anything they want, based on marketing, based on supplemental benefits, based on who's in network and who's not in network. There are a variety of factors that a patient can use to choose what plan they want to be in any given year.
What that means is that each insurance company has a much lower lifetime value, so to speak, for the patient than we do. Because if I'm an insurer, I may lose that patient the very next year because the patient can choose which insurer to be with every year. However, because we serve as a single payer that is contracted with all of the payers in a given region, even if the patient switches from one insurance company to another, there still is our financial responsibility to bear. The LTV in our system is actually much longer than any given insurance company's LTV, almost by definition, because we are contracted with all of those insurance companies. What this means, what this has as an impact on patient care is that we are uniquely incentivized from a financial standpoint to make long-term investments in a patient's health.
If I'm an insurance company, and even if an Oracle were to tell me that I can spend $1,000 today to save $100,000 in five years, I may not want to do that because in five years, I don't know if that patient's going to be my financial responsibility or not. If that patient goes to my competitor in five years or even next year, they have the freedom to do that, and I might have spent $1,000 to save my competitor $100,000. The value of the future cash flows of preventive care essentially do not, I have no guarantee that they will accrue to me as an insurance company.
Because we are a single payer that creates one delivery network that is contracted with all of the payers, we have a higher degree of certainty that if we make investments in patients' long-term health, those financial benefits in the future will have a higher likelihood of accruing to us. In fact, we see this every year. Patients switch plans, but they are still in our network. They are still our financial responsibility to bear. The long-term investments we have made in patient health over time have paid dividends in terms of lowering the trend in utilization and in costs that we are seeing relative to the market. For example, last year, our medical trend across all of our lines of business combined was just over 5% compared to the national average of close to 10% in terms of utilization and trend.
This year, we're expecting around 4.5% trend in terms of all of our lines of business on a blended basis, and we're tracking basically exactly to that in Q1 so far. In addition, our model, which I described earlier, causes fewer unnecessary hospital admissions, causes a shorter length of stay when you're in a hospital. It's not on the slide, but also causes fewer readmissions. We're not just gaming the system by pushing patients out, but then they're getting readmitted. Not only are the lengths of stay shorter, but the readmission rate is lower. Our patients are very happy with it. As I mentioned earlier, over 70% of our prior auths are approved so that you don't even have to go home sometimes before seeing the specialist that you desperately need to see.
All of this combined are causing us, again, to have profitability at a time that others are really struggling in this market. Even though industry trends are causing utilization to spike up, causing revenue to spike down because of certain changes that I'll talk about later in terms of regulatory, we have continued to grow our profitability each and every year up and to the right. The final part of the model is our ability to decrease. Sorry. Do you think I could go to the next slide on here? I'm sorry. Thank you so much. Apologies. The final part of the model is, after we've taken out the COGS or reduced the COGS as much as possible, the last part is reducing G&A as much as possible. The way we do that, my background's in computer science and AI, have an undergrad and master's degree.
The way we're doing that is by building a fully proprietary technology platform that is purpose-built to take on not only payer functions, but also enable and empower providers in their practice. We built this all in-house from scratch, purpose-built for the unique reorientation of how reimbursement works in the healthcare system. What that means is we've built our own prior authorization systems. As I mentioned earlier, over 70% of those are automatically approved via our AI agents. We built our own claims shop and our claims adjudication engine. Over 70% of those claims are also automatically adjudicated, which means providers get paid faster and more accurately. It allows us to prevent fraud, waste, and abuse, which is obviously a large priority for the administration at this point in time. We welcome all those efforts.
We are building software for the provider where they do not have to submit claims or prior auths or eligibility requests to 20 different payers that they might be partnered with. If you guys have ever been to a doctor's office, you may recall the front office staff taking your ID card, scanning it, and then logging on to whichever insurance company's portal that you belong to, and then searching what kind of copay, what kind of deductible, what kind of benefits that you have. In our system, they just log on to the Astrana portal. Everything is done for them. We scrape and gather all the information from all the different plans and display all the information in one place. All of the gaps in care, all of the risk adjustment, all of the care plans all show up in one place.
In fact, when our providers start their day, they can just log on to our system, see a view, it's integrated into the EHR, see a view of all of the appointments they have for that day, see any medical history for that patient, any recent hospitalizations, any high-risk indicators, and an AI-generated summary of that hundreds of thousands of pages of documents related to that patient all show up in kind of one neat place for the doctor so they know exactly what they have to do for each patient that day when they're doing their morning rounds. We also have pretty sophisticated fraud, waste, and abuse algorithms that can determine when there are abnormalities in claims patterns. For example, we were one of the first to find the urinary catheter fraud that CMS has now talked about.
We were participants in the skin graft fraud that many of you may have recently read a Wall Street Journal article about. We saw those, and we were able to detect those fraudulent activities because we are the ones paying all the claims, and we've used our AI algorithms to figure out where there are abnormal patterns in that claims data. I'm so sorry. Could you go to the next slide, please? This might have turned off. At the end of the day, by continuing to grow revenue via membership and revenue per membership growth, by decreasing the medical costs and expenses per member in a responsible way, and by decreasing the G&A load and the inefficiencies in the system, we've been able to build a franchise that continues to grow rapidly, that continues to become more and more profitable, and has unique tailwinds to the business.
If you go to the next slide, please. Many of you may have heard some of the volatility in the healthcare space, and I'll end here. There have been challenges around revenue, which are related to risk adjustment. There are challenges around cost, which are related primarily to increased utilization and increased cost of the healthcare system. These are causing people to act in ways that are harming patients, increased denials, increased fraud, attempts to negotiate at scale, and find arbitrage in the system. These are not things that the American healthcare system needs. These are things that are going to continue to drive waste in the system, continue to have anxiety and angst over how the healthcare system is delivered, and continue to cause some of the unfortunate events that we've seen happen over the past year. It is clearly not sustainable.
I think America is at a breaking point in terms of what needs to be done in terms of healthcare. We believe that we are part of the solution. We believe that insurance companies do not need to be creating their own networks that are all 99% the same, that are slightly different, causing extra layers of administrative burden for doctors and for the system alike. We believe that we should stop fraud, waste, and abuse in terms of fraudulent risk adjustment. We are very glad that CMS is going to be increasing the risk adjustment data validation, or RADV, audits for each and every health plan.
We believe that we'll be validated in terms of our strategy to play the high road and have accurate risk adjustment in a way that does not allow, that will not force us to have a revenue headwind like many others in the space will have over the next coming years. Finally, we believe that our unique care model in terms of having one care delivery network, in terms of having the financial incentives to invest long-term in a patient's health, will allow us and has allowed us for many years, many decades, that is, to control utilization. We believe that our zagging when others are zigging, to use Ryan's phrase at the beginning of this presentation, actually makes more sense because, as many of you may have heard, 2026 Medicare Advantage rate notice actually came out much higher than people expected.
We believe that we saw and predicted where that puck was heading and started making acquisitions, growing more quickly, deploying capital in order to lean into the increasing rate environment rather than being reactive and reducing our risk at a time when things are actually better. We believe that those who are reducing risk now are selling low, so to speak. If things are getting better, why would you want to reduce risk at a time that just because the past couple of years have been difficult? If anything, you want to increase risk at a time when the market is low, but you have very clear and obvious visibility into future rate increases. We believe that on these three very large headwinds facing the industry, our strategy and our execution has allowed us to differentiate ourselves.
We're uniquely positioned for very strong growth on both top and bottom lines for both the short and long term. With that, thank you so much for listening to me babble on today. I'm looking forward to seeing many of you at the breakout session. Thank you very much.