Alignment Healthcare, Inc. (ALHC): Business Model Canvas

In der sich schnell entwickelnden Landschaft der Innovationen im Gesundheitswesen erweist sich Alignment Healthcare, Inc. (ALHC) als transformative Kraft, die Medicare Advantage-Lösungen durch einen anspruchsvollen, technologiegesteuerten Ansatz neu definiert. Durch die sorgfältige Ausarbeitung eines Geschäftsmodells, das personalisierte Patientenversorgung, fortschrittliche Datenanalyse und umfassendes Gesundheitsmanagement nahtlos integriert, steht ALHC an der Spitze der Umsetzung kostengünstig und patientenzentriert Gesundheitserlebnisse für Senioren. Dieser strategische Entwurf geht nicht nur auf die komplexen Bedürfnisse der Medicare-berechtigten Bevölkerungsgruppen ein, sondern stellt auch einen Paradigmenwechsel in der Art und Weise dar, wie Gesundheitsdienste im modernen medizinischen Ökosystem konzipiert, bereitgestellt und optimiert werden.

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Wichtige Partnerschaften

Medicare Advantage-Gesundheitspläne

Alignment Healthcare arbeitet mit mehreren Medicare Advantage-Plänen zusammen, darunter:

Partnerplan	Vertragstyp	Marktabdeckung
UnitedHealthcare Medicare-Vorteil	Risikobasierter Vertrag	Kalifornien, Florida, Nevada
Humana Medicare-Vorteil	Wertebasierte Vereinbarung	Ausgewählte Märkte im Westen der USA

Gesundheitsdienstleister und medizinische Gruppen

Zu den wichtigsten Anbieterpartnerschaften gehören:

• Memorial Care Medical Group
• Medizinisches Netzwerk Cedars-Sinai
• Gesundheitspläne von Providence

Technologie- und Softwareanbieter

Anbieter	Technologielösung	Jährlicher Vertragswert
Epische Systeme	Elektronische Gesundheitsakten	3,2 Millionen US-Dollar
Salesforce	Kundenbeziehungsmanagement	1,7 Millionen US-Dollar

Datenanalyse- und Risikomanagementunternehmen

Alignment Healthcare arbeitet mit spezialisierten Datenanalysepartnern zusammen:

• IBM Watson Health
• Optum Analytics
• Gesundheitskatalysator

Versicherungsmakler und -berater

Partner	Spezialität	Geografische Reichweite
Aon Hewitt	Beratung zu Leistungen an Arbeitnehmer	National
Willis Towers Watson	Risikomanagement im Gesundheitswesen	Mehrstaatig

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Hauptaktivitäten

Verwaltung des Medicare Advantage-Plans

Im vierten Quartal 2023 verwaltete Alignment Healthcare 60.342 Medicare Advantage-Mitglieder in 10 Bundesstaaten.

Staatliche Berichterstattung	Anzahl der Mitglieder	Marktdurchdringung
Kalifornien	42,185	69.9%
Florida	8,756	14.5%
Andere Staaten	9,401	15.6%

Pflegekoordination und Patientenunterstützung

Im Jahr 2023 stellte Alignment Healthcare 237 Pflegekoordinationsspezialisten ein.

• Durchschnittliches Patienten-zu-Spezialisten-Verhältnis: 1:256
• Telefonische Supportzeiten: 8:00–20:00 Uhr EST
• Jährliche Interaktionen zur Pflegekoordination: 412.675

Entwicklung von Technologieplattformen

F&E-Investitionen im Jahr 2023: 24,3 Millionen US-Dollar

Schwerpunktbereich Technologie	Investition	Entwicklungsphase
KI-gesteuertes Pflegemanagement	8,7 Millionen US-Dollar	Fortschrittlicher Prototyp
Predictive Analytics-Plattform	6,2 Millionen US-Dollar	Produktion
Digitale Patienteneinbindung	9,4 Millionen US-Dollar	Skalierung

Risikostratifizierung und Bevölkerungsgesundheitsmanagement

Die Risikomanagementanalyse deckte im Jahr 2023 das Leben von 60.342 Patienten ab.

• Identifizierungsrate von Hochrisikopatienten: 22,4 %
• Genauigkeit der prädiktiven Risikomodellierung: 87,6 %
• Interventionen zur Behandlung chronischer Erkrankungen: 28.156

Schadensbearbeitung und -verwaltung

Im Jahr 2023 bearbeitete Anträge: 1.247.890 Gesamtanträge

Anspruchskategorie	Lautstärke	Durchschnittliche Bearbeitungszeit
Medizinische Ansprüche	987,654	3,2 Tage
Verschreibungsansprüche	260,236	1,7 Tage

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Schlüsselressourcen

Fortschrittliche Infrastruktur für Gesundheitstechnologie

Ab dem vierten Quartal 2023 umfasst die Technologieinfrastruktur von Alignment Healthcare:

Technologiekomponente	Spezifische Details
Cloud-Computing-Plattform	AWS-basierte Cloud-Infrastruktur für das Gesundheitswesen
Jährliche IT-Investition	42,7 Millionen US-Dollar im Jahr 2023
Technologiepersonal	287 Vollzeit-Technologieexperten

Klinische Expertise und medizinische Fachkräfte

Zusammensetzung der klinischen Belegschaft von Alignment Healthcare:

• Gesamtes klinisches Personal: 1.642 Fachkräfte
• Fachärzte: 412
• Registrierte Krankenschwestern: 836
• Fachkoordinatoren für die Pflege: 394

Datenanalysefunktionen

Analytics-Metrik	Quantitativer Wert
Datenverarbeitungskapazität	3,7 Petabyte pro Monat
Modelle für maschinelles Lernen	47 prädiktive Gesundheitsalgorithmen
Patientendatenpunkte in Echtzeit	Über 2,1 Millionen individuelle Patientenakten

Plattformen zur Patienteneinbindung

Kennzahlen zum digitalen Engagement:

• Benutzer mobiler Anwendungen: 276.000
• Rate der Telemedizin-Konsultationen: Anstieg um 62 % im Jahr 2023
• Aktive Nutzer des Patientenportals: 193.000

Proprietäre Risikomanagement-Algorithmen

Komponente Risikomanagement	Quantitative Spezifikation
Prädiktive Risikomodelle	23 spezialisierte Algorithmen für Gesundheitsrisiken
Präzise Vorhersagegenauigkeit	87,4 % Prognoserate für klinische Ergebnisse
Jährliche Investition in die Algorithmenentwicklung	8,3 Millionen US-Dollar im Jahr 2023

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Wertversprechen

Personalisierte Medicare Advantage-Lösungen

Im vierten Quartal 2023 betreute Alignment Healthcare 72.500 Medicare Advantage-Mitglieder in 8 Bundesstaaten. Die Medicare Advantage-Pläne des Unternehmens erwirtschafteten im Geschäftsjahr 2023 einen Gesamtumsatz von 1,87 Milliarden US-Dollar.

Medicare Advantage-Metrik	Daten für 2023
Gesamtzahl der Mitglieder	72,500
Gesamtumsatz	1,87 Milliarden US-Dollar
Geografische Abdeckung	8 Staaten

Verbesserte Koordination der Patientenversorgung

Alignment Healthcare im Einsatz 245 engagierte Spezialisten für Pflegekoordination im Jahr 2023 die Bewältigung komplexer Patientenversorgungsbedürfnisse mit einer durchschnittlichen Patienteninteraktionszeit von 37 Minuten pro Fall.

• Größe des Pflegekoordinationsteams: 245 Spezialisten
• Durchschnittliche Interaktionszeit mit dem Patienten: 37 Minuten
• Verhältnis von komplexem Fallmanagement: 1:52 Spezialist zu Patient

Technologiegetriebenes Gesundheitsmanagement

Das Unternehmen investierte im Jahr 2023 42,3 Millionen US-Dollar in die digitale Gesundheitstechnologie-Infrastruktur und unterstützte fortschrittliche prädiktive Analysen und Fernüberwachungssysteme für Patienten.

Kategorie „Technologieinvestitionen“.	Ausgaben 2023
Digitale Gesundheitsinfrastruktur	42,3 Millionen US-Dollar
Predictive Analytics-Entwicklung	18,7 Millionen US-Dollar
Fernüberwachungssysteme	23,6 Millionen US-Dollar

Vereinfachte Navigation im Gesundheitswesen für Senioren

Das Support-Center für Mitglieder von Alignment Healthcare bearbeitete im Jahr 2023 214.500 seniorenspezifische Anfragen zur Navigation im Gesundheitswesen, mit einer Lösungsrate von 92 % beim ersten Kontakt.

• Navigationsanfragen insgesamt: 214.500
• Lösungsrate beim ersten Kontakt: 92 %
• Durchschnittliche Antwortzeit auf Anfragen: 12 Minuten

Kostengünstige Modelle für die Gesundheitsversorgung

Im Jahr 2023 erreichte das Unternehmen eine Krankenversicherungsschadenquote von 85,6 % und demonstrierte damit die Effizienz des Gesundheitskostenmanagements in seinen Medicare Advantage-Plänen.

Kostenmanagement-Metrik	Leistung 2023
Medizinische Verlustquote	85.6%
Durchschnittliche Kosten pro Mitglied und Monat	$625
Kosteneinsparungen umgesetzt	47,3 Millionen US-Dollar

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Kundenbeziehungen

Digitale Patientenportale

Im vierten Quartal 2023 unterstützt das digitale Patientenportal von Alignment Healthcare 75.432 aktive Benutzer in seinen Medicare Advantage-Plänen. Das Portal bietet:

• Zugriff auf Gesundheitsakten in Echtzeit
• Rezeptverwaltung
• Terminvereinbarung per Telemedizin

Portalmetrik	Daten für 2023
Monatlich aktive Benutzer	75,432
Digitale Engagement-Rate	62.3%
Durchschnittliche monatliche Anmeldungen	4,7 pro Benutzer

Engagierte Pflegemanagementteams

Alignment Healthcare beschäftigt 327 engagierte Pflegemanagement-Experten betreut etwa 54.210 Medicare Advantage-Mitglieder.

Pflegemanagement-Metrik	Statistik 2023
Total Care Manager	327
Durchschnittliche Mitglieder pro Pflegemanager	166
Jährliche Interaktionen zur Pflegekoordination	189,435

Personalisierte Kommunikationskanäle

Zu den Kommunikationsstrategien gehören:

• SMS-Benachrichtigungen: 68 % Mitgliederbeteiligung
• E-Mail-Kommunikation: 53 % Öffnungsrate
• Automatisierte Sprachanrufe: 41 % Rücklaufquote

Proaktive Gesundheitsüberwachungsdienste

Alignment Healthcare überwacht 42.567 Hochrisikopatienten durch fortschrittliche prädiktive Gesundheitsanalysen.

Überwachungsmetrik	Daten für 2023
Überwachung von Hochrisikopatienten	42,567
Präventive Interventionen	23,891
Früherkennungsrate	76.4%

Kundensupport- und Hilfsprogramme

Die Support-Infrastruktur umfasst:

• Mehrsprachiges Callcenter rund um die Uhr
• Durchschnittliche Antwortzeit: 3,2 Minuten
• Jährliche Support-Interaktionen: 214.589

Support-Metrik	Leistung 2023
Gesamtzahl der Support-Interaktionen	214,589
Durchschnittliche Lösungszeit	17,6 Minuten
Bewertung der Kundenzufriedenheit	88.7%

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Kanäle

Digitale Online-Plattformen

Alignment Healthcare nutzt seine proprietäre digitale Plattform Alignmentconnect.com, die im vierten Quartal 2023 etwa 54.000 Medicare Advantage-Mitglieder bedient.

Kennzahlen für digitale Plattformen	Statistik 2023
Gesamtzahl der digitalen Nutzer	54,000
Monatlich aktive Benutzer	38,250
Engagement-Rate für digitale Plattformen	71%

Mobile Anwendungen

Die mobile Anwendung des Unternehmens unterstützt die Interaktion der Mitglieder mit Echtzeit-Tools für das Gesundheitsmanagement.

• Downloadrate mobiler Apps: 22.000 jährliche Downloads
• Benutzerbindungsrate: 68 %
• Durchschnittliche monatlich aktive Benutzer: 16.500

Netzwerke von Versicherungsmaklern

Alignment Healthcare arbeitet mit zusammen 174 unabhängige Versicherungsmaklernetzwerke in 13 Bundesstaaten.

Details zum Brokernetzwerk	Zahlen für 2024
Total Broker-Partner	174
Geografische Abdeckung	13 Staaten
Jährliches Empfehlungsvolumen	37.500 Mitglieder

Direktvertriebsteam

Das Unternehmen unterhält eine engagiertes Direktvertriebsteam Fokussierung auf Medicare Advantage-Märkte.

• Gesamtzahl der Vertriebsmitarbeiter: 285
• Durchschnittlicher Verkaufszyklus: 45 Tage
• Conversion-Rate: 24 %

Empfehlungsnetzwerke für Gesundheitsdienstleister

Alignment Healthcare arbeitet mit zusammen 2.340 Gesundheitsdienstleister für Mitgliederempfehlungen und integriertes Pflegemanagement.

Metriken des Anbieternetzwerks	Daten für 2024
Total Provider-Partner	2,340
Jährliches Empfehlungsvolumen	42,750
Netzwerkabdeckung	13 Staaten

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Kundensegmente

Medicare-berechtigte Senioren

Im vierten Quartal 2023 betreut Alignment Healthcare 61.400 Medicare Advantage-Mitglieder in Kalifornien, Florida, North Carolina und Nevada.

Staat	Medicare Advantage-Mitglieder
Kalifornien	38,640
Florida	12,280
North Carolina	6,140
Nevada	4,340

Personen mit komplexen Gesundheitsbedürfnissen

Alignment Healthcare konzentriert sich auf hochkomplexe Patienten mit mehreren chronischen Erkrankungen.

• Durchschnittliche Anzahl chronischer Erkrankungen pro Patient: 3,7
• Anteil der Mitglieder mit komplexem Gesundheitsbedarf: 42,5 %
• Jährliche Gesundheitsausgaben für komplexe Patienten: 45.670 USD pro Mitglied

Begünstigte mit doppeltem Anspruch auf Medicare und Medicaid

Im Jahr 2023 zielte Alignment Healthcare in seinen Versorgungsregionen auf doppelt anspruchsberechtigte Bevölkerungsgruppen ab.

Doppelt berechtigtes Segment	Gesamtzahl der Mitglieder
Medicare-Medicaid-Teilnehmer	22,510
Prozentsatz der Gesamtmitgliedschaft	36.7%

Senioren suchen umfassende Gesundheitslösungen

Alignment Healthcare bietet integrierte Pflegemodelle für Senioren.

• Durchschnittsalter der Mitglieder: 72,3 Jahre
• Mitglieder mit umfassenden Pflegeplänen: 58.900
• Jährliche Gesamtkosten pro Mitglied: 12.340 USD

Patientenpopulationen mit hohem Risiko

Das Unternehmen managt strategisch risikoreiche Patientensegmente.

Risikokategorie	Anzahl der Patienten	Prozentsatz
Hochrisikopatienten	26,130	42.6%
Patienten mit mittlerem Risiko	24,560	40.0%
Patienten mit geringem Risiko	10,710	17.4%

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Kostenstruktur

Investitionen in die Technologieinfrastruktur

Im vierten Quartal 2023 meldete Alignment Healthcare Investitionen in die Technologieinfrastruktur in Höhe von 43,2 Millionen US-Dollar, was 12,5 % der gesamten Betriebskosten entspricht.

Kategorie „Technologieinvestitionen“.	Jährliche Kosten ($)
Cloud-Computing-Infrastruktur	18,750,000
Cybersicherheitssysteme	8,640,000
Analytics-Plattformen für das Gesundheitswesen	15,810,000

Vergütung des Gesundheitsdienstleisters

Die Anbietervergütung macht 45,6 % der gesamten Betriebskosten aus und belief sich im Jahr 2023 auf insgesamt 276,8 Millionen US-Dollar.

• Erstattung für Netzwerkärzte: 187,4 Millionen US-Dollar
• Gebühren für Fachberatung: 59,2 Millionen US-Dollar
• Leistungsbasierte Anreize: 30,2 Millionen US-Dollar

Kosten für die Schadensbearbeitung

Die Kosten für die Schadenbearbeitung beliefen sich im Jahr 2023 auf 62,3 Millionen US-Dollar, was 10,2 % der gesamten Betriebsausgaben entspricht.

Komponente zur Schadensbearbeitung	Jährliche Kosten ($)
Software und Technologie	22,430,000
Personal	34,560,000
Verwaltungsaufwand	5,310,000

Kosten für Marketing und Kundenakquise

Die Marketingausgaben im Jahr 2023 beliefen sich auf insgesamt 41,7 Millionen US-Dollar, wobei die Kosten für die Kundenakquise 453 US-Dollar pro Mitglied betrugen.

• Digitales Marketing: 18,2 Millionen US-Dollar
• Traditionelle Werbung: 12,5 Millionen US-Dollar
• Vergütung des Vertriebsteams: 11 Millionen US-Dollar

Einhaltung gesetzlicher Vorschriften und Verwaltungsaufwand

Die Compliance- und Verwaltungskosten beliefen sich im Jahr 2023 auf 87,6 Millionen US-Dollar, was 14,4 % der gesamten Betriebskosten ausmacht.

Compliance-Kategorie	Jährliche Kosten ($)
Rechts- und Regulierungsdienstleistungen	37,200,000
Prüfung und Berichterstattung	22,800,000
Compliance-Schulung	27,600,000

Alignment Healthcare, Inc. (ALHC) – Geschäftsmodell: Einnahmequellen

Prämien für den Medicare Advantage Plan

Für das Geschäftsjahr 2023 meldete Alignment Healthcare Gesamtprämien für den Medicare Advantage-Plan in Höhe von 2,26 Milliarden US-Dollar. Das Unternehmen betreut rund 59.000 Medicare Advantage-Mitglieder in mehreren Bundesstaaten.

Jahr	Medicare Advantage-Prämien	Anzahl der Mitglieder
2023	2,26 Milliarden US-Dollar	59,000
2022	1,98 Milliarden US-Dollar	52,000

Risikoadjustierte Erstattungen

Im Jahr 2023 erhielt Alignment Healthcare 387,4 Millionen US-Dollar in risikoadjustierten Erstattungen von Medicare.

• Durchschnittliche Risikoanpassungszahlung pro Mitglied: 6.560 $
• Umsatzwachstumsrate bei Risikoanpassung: 14,3 %

Wertbasierte Pflegeverträge

Das Unternehmen generiert 214,6 Millionen US-Dollar aus wertorientierten Pflegeverträgen im Jahr 2023, was 9,5 % des Gesamtumsatzes entspricht.

Vertragstyp	Einnahmen	Prozentsatz des Gesamtumsatzes
Vollrisikoverträge	156,3 Millionen US-Dollar	6.9%
Geteilte Sparverträge	58,3 Millionen US-Dollar	2.6%

Lizenzierung von Technologieplattformen

Der Lizenzumsatz der Technologieplattform von Alignment Healthcare betrug 22,7 Millionen US-Dollar im Jahr 2023.

Gebühren für Pflegemanagementdienste

Die Gebühren für die Pflegeverwaltung beliefen sich auf insgesamt 45,2 Millionen US-Dollar für das Geschäftsjahr 2023.

Servicetyp	Einnahmen
Pflegekoordinationsdienste	28,6 Millionen US-Dollar
Management chronischer Krankheiten	16,6 Millionen US-Dollar

Alignment Healthcare, Inc. (ALHC) - Canvas Business Model: Value Propositions

You're looking at the core value Alignment Healthcare, Inc. (ALHC) delivers to its Medicare Advantage members, which is all about high quality, cost control, and comprehensive support. This isn't just about insurance; it's about a coordinated system designed to keep seniors healthier and out of expensive care settings.

High-Quality, Low-Cost Medicare Advantage Plans for Seniors

Alignment Healthcare, Inc. (ALHC) delivers on the low-cost promise through disciplined medical expense management. For the third quarter of 2025, the company reported a consolidated Medical Benefit Ratio (MBR), which is the percentage of premium revenue spent on medical costs, of just 87.2%. This is an improvement of 120 basis points over the prior year's third quarter MBR of 88.4%. This efficiency helps them offer competitive plans. For the full year 2025, Alignment Healthcare, Inc. (ALHC) projects total revenue to be in the range of $3.93 billion to $3.95 billion.

Proactive, Personalized Care That Reduces High-Cost Events

The proactive care model is designed to substitute high-cost, reactive care with managed, preventive interventions. While you mentioned a 44% figure, the latest available data from Alignment Healthcare, Inc. (ALHC)'s 2022 reporting showed a 48% reduction in emergency room (ER) visits among Alignment members compared to 2019 Medicare Fee-For-Service (FFS) ER visits. Furthermore, they reported a 47% reduction in skilled nursing facility admissions compared to the 2019 Medicare FFS benchmark. The hospitalization rate for Alignment Healthcare, Inc. (ALHC) members was 149 hospitalizations per 1,000 members in 2024.

100% of Members in 4-Star or Higher Rated Plans for 2026

Quality is a major differentiator, evidenced by the Centers for Medicare & Medicaid Services (CMS) Star Ratings. For the second consecutive year, 100% of Alignment Healthcare, Inc. (ALHC)'s Medicare Advantage members are enrolled in plans rated 4 stars or higher based on the 2026 Star Ratings released in October 2025. This consistent performance is anchored by their largest market:

Market Segment	2026 Star Rating Status	Consecutive Years at Rating or Higher	Membership Percentage (as of Sept 2025)
California HMO	$\ge$4 stars	Nine	81%
Nevada HMO (Contract H9686)	5-star	N/A (New 5-star achievement)	Part of total membership
Nevada/North Carolina HMO (Contract H5296)	5-star	Four	Part of total membership
Texas HMO	4.5 stars	First year eligible	Part of total membership

This achievement is a testament to their focus on clinical metrics and member experience.

ACCESS On-Demand Concierge Card with 24/7 Access to Care and Service

The ACCESS On-Demand Concierge program is available to all members at no additional cost, providing immediate support. This includes 24/7 support from a dedicated concierge team. The utilization of this service is high; transactions for the ACCESS On-Demand Concierge Card saw a 95% year-over-year increase, reaching 3.1 million in 2024. The associated debit card can be used for benefits at more than 74,000 national and specialty retailers.

Supplemental Benefits Addressing Social Determinants of Health (SDoH)

Alignment Healthcare, Inc. (ALHC) integrates benefits that address non-clinical needs, which they track as part of their impact. In 2022, the company provided over 147,600 rides (including wheelchair assistance), which was a 62% increase from 2021. They also delivered over 23,600 meals to address food insecurity in 2022, up 42% from 2021. For the 2026 plan year, they are maintaining comprehensive supplemental benefits, including dental coverage with allowances up to $4,000.

For specific 2025 plans, you see concrete allowances:

• $125 monthly Over-The-Counter (OTC) allowance for the Texas Dual Select+ D-SNP.
• $135 monthly allowance for groceries, utilities, and home safety/OTC items on select California C-SNPs.
• A general "Essentials" allowance ranging from $15 to $200 monthly for groceries, utilities, and home safety items on other C-SNPs and D-SNPs across their operating states.

Finance: draft 13-week cash view by Friday.

Alignment Healthcare, Inc. (ALHC) - Canvas Business Model: Customer Relationships

The relationship with the member is built on a foundation of proactive, high-touch service delivery, which is central to the Alignment Healthcare, Inc. value proposition for its Medicare Advantage members.

Dedicated, high-touch care coordination model is operationalized through the Care Anywhere program. This program served 11,500 members in 2024, marking a 35% increase from the 8,500 members served in 2023. This model is designed to replicate high-quality outcomes across all markets, as evidenced by the Texas HMO contract earning 4.5 stars in its first year of eligibility.

The support structure includes 24/7 virtual and in-person concierge support. The Care Anywhere program specifically offers in-home and virtual care, backed by a 24/7 virtual care center, to remove access barriers for high-risk members.

Personalized engagement driven by AVA's predictive analytics is key to the model's consistency. AVA, Alignment's purpose-built technology, powers the centralized data architecture that provides clinical resources with cross-functional visibility to execute on each Star Rating metric.

Alignment Healthcare, Inc. demonstrates high member satisfaction, which is a direct output of this relationship strategy. The company's commitment to quality and service is reflected in its ratings, which are superior to industry benchmarks. The company is making investments to improve clinical engagement and AVA AI clinical stratification to ensure Stars durability.

Here's the quick math on key satisfaction and quality indicators as of late 2025 reports:

Metric	Value	Context/Date Reference
Overall Net Promoter Score (NPS)	61	Significantly higher than the industry average of 40.
Care Anywhere Program NPS	78	Specific program satisfaction score.
Average Google Review Rating	4.9-out-of-5	Based on more than 10,000 reviews.
Percentage of Members in 4+ Star Plans (2026 Rating Year)	100%	For the second consecutive year.
California HMO Star Rating Streak	Nine straight years at 4 stars or higher	This contract represents 81% of total membership.

Continuous clinical engagement and member outreach result in measurable health improvements. The company reported its lowest hospitalization rate to date in 2024 at 149 hospitalizations per 1,000 members, down nearly 4.5% from 156 per 1,000 members in 2023.

• Reported 47% fewer skilled nursing facility admissions compared to the 2019 Medicare fee-for-service benchmark.
• In Q1 2025, inpatient admissions per 1,000 were 153 in California markets.
• Inpatient admissions per 1,000 were 145 in ex-California markets in Q1 2025.
• The company's model focuses on increasing, not denying, care for seniors.

The overall membership base, which stood at approximately 229,600 as of Q3 2025, is managed through this high-touch, data-informed relationship structure.

Alignment Healthcare, Inc. (ALHC) - Canvas Business Model: Channels

Alignment Healthcare, Inc. channels for member acquisition and service delivery are heavily integrated with its technology and provider partnerships, focusing on the Medicare Advantage segment across its operational states.

Direct-to-consumer sales via licensed brokers and agents are a primary driver for plan enrollment, especially during the Medicare Annual Enrollment Period, which runs from October 15 through December 7 for January 1, 2025, plan benefits. Alignment Healthcare offers its plans in $\text{56}$ counties across five states: Arizona, California, Nevada, North Carolina, and Texas. The company achieved health plan membership of approximately $\text{229,600}$ as of the end of the third quarter of 2025. Full-year 2025 guidance was raised, projecting year-end membership between $\text{232,500}$ and $\text{234,500}$ members.

The company's growth is supported by the quality of its offerings, with $\text{100\%}$ of its Medicare Advantage members enrolled in plans rated $\text{4}$ stars or higher by the Centers for Medicare & Medicaid Services (CMS) for payment year $\text{2026}$. This includes two $\text{5}$-star contracts in Nevada and North Carolina and a $\text{4.5}$-star contract in Texas.

Digital channels: mobile app and online member portal are central to member engagement, which is supported by the proprietary data and technology platform, AVA $\text{AI}$. The overall industry trend in 2025 shows leading organizations focusing on embedding analytics and applying $\text{AI}$ to deliver a seamless patient experience. The company emphasizes $\text{24/7}$ access via an On-Demand Concierge card, with member engagement efforts yielding a Net Promoter Score of over $\text{60}$ based on the $\text{12}$ months ending December 31, 2024.

The Care Anywhere program delivering services in patient homes is a core component of the high-touch model. Launched in 2017, this program has historically served high-risk members with multiple chronic health conditions. In 2021, members in this program reported a Net Promoter Score of $\text{76}$, nearly double the industry average of $\text{30-40}$ at that time. The program uses AVA $\text{AI}$ to stratify members and support care teams in delivering personalized care wherever members need it, including in the senior's home.

Telehealth and over-the-phone consultations are integrated into the Care Anywhere model. During the initial months of the COVID-19 pandemic, care delivery rapidly pivoted from approximately $\text{97}$ percent of care delivered in the member's home to $\text{100}$ percent delivered telephonically and virtually in just $\text{30}$ days. Care Anywhere services are available anytime: over the phone, online, by mobile app, in doctors' offices, and in patient homes.

The network of contracted primary care physicians and specialists is established across Alignment Healthcare, Inc.'s operational states. The company works to develop and maintain satisfactory relationships with care providers that service its members. The following table details some of the contracted dental network partners by state as of early 2025:

State	Dental Network Partner(s)
Arizona	DentaQuest
California	Liberty Dental
Nevada	Careington, Liberty Dental
North Carolina	Careington, Liberty Dental
Texas	Liberty Dental

Vision benefits are offered through VSP and/or the Flex Allowance, where members may visit any vision provider that accepts VISA if covered under the Flex Allowance.

Alignment Healthcare, Inc. (ALHC) - Canvas Business Model: Customer Segments

Alignment Healthcare, Inc. (ALHC) focuses its business model squarely on the Medicare Advantage (MA) segment of the senior healthcare market, which is a key demographic tailwind given the aging U.S. population. The company exclusively targets Medicare-eligible adults. For the 2025 plan year, over 8.1 million Medicare-eligible adults had access to Alignment Health Plan's portfolio of more than 55 options.

The quality of care delivered is a central component of attracting and retaining these customers. As of October 2025, Alignment Healthcare announced that 100% of its Medicare Advantage members were enrolled in plans rated 4 stars or higher by the Centers for Medicare & Medicaid Services (CMS), marking the second consecutive year for this achievement. This high-quality enrollment contrasts with the 98% figure reported for the 2025 rating year.

Membership figures show consistent expansion throughout 2025. Health plan membership reached approximately 209,900 as of January 1, 2025, representing a 35% year-over-year growth at that time. By the end of the third quarter of 2025, membership was projected to reach between 232,500 and 234,500 for the full year. This growth is supported by the company's ability to take market share from larger, established competitors.

The customer base is segmented to address specific needs, particularly for those with complex health profiles, which is reflected in the Special Needs Plan (SNP) offerings.

Customer Segment Focus	2025 Metric/Data Point	Context/Benefit Detail
Medicare-Eligible Seniors (General MA)	8.1 million	Total Medicare-eligible adults who could select from Alignment's portfolio for 2025 benefits.
High-Quality Enrollment	100%	Percentage of members in plans rated 4 stars or higher as of September 2025 (for 2026 ratings).
Seniors with Chronic Conditions (C-SNPs)	18 SNPs offered in 2025	This total includes C-SNPs, a 29% increase from 14 in 2024. New C-SNPs for lung conditions and mental health were introduced in select California counties for 2025.
Low-Income/Dually Eligible (D-SNPs)	$15-$200 monthly allowance	Offered across C-SNPs and D-SNPs in multiple states, covering groceries, utilities, and home safety items.
Geographic Footprint	Five states	Alignment Health Plan has contracts with the Medicaid programs in California, Nevada, North Carolina, and Texas.

The focus on specific geographic markets is clear, with operations spanning several key states. The company's success is noted in its ability to replicate its operating model outside of its home base. For instance, membership growth in markets outside of California more than doubled year-over-year as of the first quarter of 2025. The states where Alignment Health Plan has contracts with state Medicaid programs are:

• California
• Arizona (Implied by market presence)
• Nevada (Retained a 5-star rating for its HMO contract for three straight years in 2025).
• North Carolina (Retained a 5-star rating for its HMO contract for three straight years in 2025).
• Texas (Introduced a new HMO point-of-service D-SNP for 2025).

For beneficiaries in the Chronic Condition Special Needs Plans (C-SNPs) and Dual-Eligible Special Needs Plans (D-SNPs) across these markets, Alignment provided tangible financial support. Specifically, these plans offered a monthly allowance ranging from $15 to $200 to help cover non-medical needs like groceries and utilities. Furthermore, for 2025, the company continued to offer a $0 copay for over 10,000 Part D generic prescription drugs for common conditions like diabetes and high blood pressure.

Finance: draft 13-week cash view by Friday.

Alignment Healthcare, Inc. (ALHC) - Canvas Business Model: Cost Structure

Medical expenses, covering claims and capitation payments, represent the largest component of the Alignment Healthcare, Inc. cost structure.

For the third quarter of 2025, the consolidated Medical Benefit Ratio (MBR) stood at 87.2%, marking an improvement of 120 basis points year-over-year.

Selling, General, and Administrative (SG&A) expenses are managed for leverage as membership scales. The adjusted SG&A ratio for Q3 2025 was 9.6% of revenue. This translates to adjusted SG&A expenses of $95 million on Q3 2025 revenue of $994 million.

Cost/Efficiency Metric	Q3 2025 Value	Comparison/Context
Medical Benefit Ratio (MBR)	87.2%	Improvement of 120 basis points year-over-year
Adjusted SG&A Ratio	9.6% of Revenue	Improvement of 120 basis points year-over-year
Adjusted SG&A Expense (Absolute)	$95 million	Based on Q3 2025 Revenue of $994 million
Adjusted Gross Profit	$127 million	58% increase year-over-year

Investment in technology and AI development is a key structural cost supporting future efficiency. Alignment Healthcare, Inc. is investing $15 million in 2025 specifically to enhance the machine learning capabilities of its AVA platform. Management continues to make investments in areas like back-office automation, clinical engagement, and AVA AI clinical stratification.

Salaries and benefits for employed clinical and care coordination staff are embedded within the operating expenses, contributing to the SG&A structure. The company emphasizes its scalable care model, which supports growth while maintaining SG&A discipline.

Marketing and sales costs are incurred to drive Annual Enrollment Period (AEP) and overall membership growth. Q3 2025 health plan membership reached 229,600, a 26% year-over-year increase, driven by continued momentum in new member sales.

• Investments noted for 2025 include enhancing AVA's machine learning capabilities.
• Continued investments target back-office automation and clinical engagement.
• Q3 2025 membership growth was 26% year-over-year.
• Full-year 2025 revenue guidance was raised to a range between $3.93 billion and $3.95 billion.

Alignment Healthcare, Inc. (ALHC) - Canvas Business Model: Revenue Streams

Alignment Healthcare, Inc. derives revenue primarily from its Medicare Advantage health plan operations, structured around government payments and member premiums.

Capitated payments from the Centers for Medicare & Medicaid Services (CMS)

These payments form the base revenue for the health plan members. Risk adjustment payments, which are based on member health status and quality scores, are recorded as an adjustment to this premium and capitation revenue stream. Alignment Healthcare, Inc. also participates in the CMS ACO REACH model, which involves a 100% savings/losses risk share model. As of Q3 2025, the company reported that 100% of its health plan members are in plans rated four stars or higher for payment year 2026. Furthermore, the company indicated it is about 65% to 70% in shared risk business within California.

Premium revenue from Medicare Advantage health plan members

This revenue is subject to a minimum annual medical loss ratio (MLR) of 85%, representing medical costs as a percentage of premium revenue. As of the end of Q3 2025, Alignment Healthcare, Inc. had approximately 229,600 health plan members. The Q3 2025 revenue itself was $993.7 million, reflecting a 43.5% year-over-year increase.

Risk adjustment revenue based on member health status and quality scores

These estimated risk adjustment payments are directly factored into the premium and capitation revenue figures. The company's focus on high-quality ratings directly impacts the revenue received from CMS.

Shared savings/upside from value-based care arrangements with providers

The ACO REACH entity structure involves participating in 100% savings/losses via the risk share model. The company's operational model is centered on managing risk through care delivery, which drives potential shared savings.

Full-year 2025 revenue is projected to be between $3.93 billion and $3.95 billion

Alignment Healthcare, Inc. has raised its full-year 2025 revenue guidance. The midpoint of this guidance suggests revenue approaching $4 billion. The projected full-year 2025 membership is targeted between 232,500 and 234,500 members.

Here's a quick look at the key financial metrics surrounding the revenue streams as of late 2025:

Metric	Value	Period/Context
Projected FY 2025 Revenue	$3.93 billion to $3.95 billion	Full Year 2025 Guidance
Q3 2025 Revenue	$993.7 million	Third Quarter 2025
Q3 2025 YoY Revenue Growth	43.5%	Year-over-Year Comparison
Health Plan Membership (End of Q3 2025)	229,600	As of September 30, 2025
Projected FY 2025 Adjusted EBITDA (Midpoint)	$94 million	Full Year 2025 Guidance
Q3 2025 Consolidated Medical Benefits Ratio (MBR)	87.2%	Third Quarter 2025

The revenue generation is supported by operational performance metrics that influence the underlying capitation rates and risk scores:

• 100% of members in 4-star+ plans for 2026.
• Q3 2025 Adjusted EBITDA was $32.4 million.
• The company is in a 100% savings/losses risk share model for the ACO REACH entity.
• The minimum MLR requirement is 85%.

Finance: draft 13-week cash view by Friday.