Elevance Health Inc. (ELV): Business Model Canvas

In der dynamischen Landschaft der Krankenversicherung entwickelt sich Elevance Health Inc. (ELV) zu einem transformativen Kraftpaket, das die Art und Weise, wie Amerikaner Zugang zu medizinischer Versorgung erhalten und diese erleben, neu definiert. Dieses innovative Unternehmen hat sorgfältig ein Geschäftsmodell entwickelt, das über die traditionelle Versicherung hinausgeht und modernste digitale Technologien, umfassende Wellnessprogramme und personalisierte Gesundheitslösungen integriert. Durch die strategische Nutzung eines umfangreichen Netzwerks aus Partnerschaften und fortschrittlicher Datenanalyse verkauft Elevance Health nicht nur Versicherungen, sondern revolutioniert das gesamte Gesundheitsökosystem und macht umfassende, kostengünstige und technologisch fortschrittliche medizinische Versorgung für Millionen von Menschen in verschiedenen Kundensegmenten zugänglich.

Elevance Health Inc. (ELV) – Geschäftsmodell: Wichtige Partnerschaften

Gesundheitsdienstleister und Krankenhäuser im ganzen Land

Elevance Health unterhält ab 2023 Partnerschaften mit rund 106.000 Hausärzten und 510.000 Fachärzten. Das Unternehmen unterhält Vertragsbeziehungen mit über 4.700 Krankenhäusern im ganzen Land.

Partnerschaftstyp	Anzahl der Anbieter	Abdeckungsbereich
Hausärzte	106,000	Bundesweit
Fachärzte	510,000	Bundesweit
Krankenhäuser	4,700	Bundesweit

Pharmaceutical Benefit Manager (PBMs)

Elevance Health besitzt IngenioRx, eines der größten PBMs in den Vereinigten Staaten, das rund 45 Millionen Mitglieder betreut.

• PBM-Marktanteil: Ungefähr 7,5 % des gesamten PBM-Marktes
• Jährlich bearbeitete Rezeptanträge: Über 1,2 Milliarden

Partner für Technologie und digitale Gesundheitslösungen

Elevance Health arbeitet mit mehreren Technologiepartnern zusammen, um digitale Gesundheitslösungen zu verbessern.

Partnerkategorie	Anzahl der Partnerschaften	Fokusbereich
Telegesundheitsplattformen	12	Fernversorgung im Gesundheitswesen
KI-Lösungen für das Gesundheitswesen	8	Prädiktive Analytik
Digitale Gesundheitsüberwachung	15	Patienteneinbindung

Staatliche Gesundheitsprogramme

Elevance Health beteiligt sich an mehreren staatlichen Gesundheitsprogrammen in verschiedenen Bundesstaaten.

• Medicaid-Verträge: Aktiv in 19 Bundesstaaten
• Medicare Advantage-Mitglieder: Über 2,3 Millionen
• Gesamtzahl der Mitglieder des Regierungsprogramms: Ungefähr 6,5 Millionen

Versicherungs- und Rückversicherungsunternehmen

Elevance Health unterhält strategische Partnerschaften mit mehreren Versicherungs- und Rückversicherungsunternehmen.

Partnerschaftstyp	Anzahl der Partner	Risikominderungsschutz
Rückversicherungsunternehmen	7	Gesamtdeckungssumme: 5,2 Milliarden US-Dollar
Regionale Versicherungspartner	23	Landesweite Risikoteilung

Elevance Health Inc. (ELV) – Geschäftsmodell: Hauptaktivitäten

Krankenversicherung und Krankenversicherungsmanagement

Elevance Health verwaltet ab 2023 den Krankenversicherungsschutz für rund 47,5 Millionen Mitglieder in verschiedenen Segmenten. Das Unternehmen ist in 14 Bundesstaaten mit umfassenden Krankenversicherungsplänen tätig.

Abdeckungssegment	Anzahl der Mitglieder
Gewerbliche Versicherung	28,3 Millionen
Medicare	8,9 Millionen
Medicaid	10,3 Millionen

Schadensbearbeitung und -verwaltung

Elevance Health bearbeitet jährlich etwa 250 Millionen Schadensfälle mit einer digitalen Bearbeitungseffizienz von 92 %. Das Schadenverwaltungssystem des Unternehmens verwaltet:

• Medizinische Ansprüche
• Apothekenansprüche
• Zahnärztliche Ansprüche
• Visionsansprüche

Entwicklung eines Gesundheitsnetzwerks

Das Unternehmen unterhält ein Netzwerk von 106.000 Gesundheitsdienstleistern und 6.200 Krankenhäusern in seinen Betriebsstaaten. Die Netzwerkzusammensetzung umfasst:

Anbietertyp	Nummer
Hausärzte	48,500
Fachärzte	57,500

Innovation in der digitalen Gesundheitstechnologie

Elevance Health investierte im Jahr 2023 782 Millionen US-Dollar in digitale Gesundheitstechnologien. Zu den wichtigsten technologischen Investitionen gehören:

• Telemedizin-Plattformen
• KI-gesteuerte Gesundheitsüberwachungssysteme
• Mobile Gesundheitsanwendungen
• Integration elektronischer Patientenakten

Gestaltung von Wellness- und Vorsorgeprogrammen

Das Unternehmen führt Wellnessprogramme für 35,6 Millionen Mitglieder durch und investiert jährlich 425 Millionen US-Dollar in Präventionsinitiativen.

Programmkategorie	Jährliche Teilnehmer
Management chronischer Krankheiten	12,3 Millionen
Unterstützung der psychischen Gesundheit	8,7 Millionen
Fitness- und Ernährungsprogramme	14,6 Millionen

Elevance Health Inc. (ELV) – Geschäftsmodell: Schlüsselressourcen

Umfangreiches Netzwerk von Gesundheitsdienstleistern

Ab 2024 unterhält Elevance Health ein umfassendes Netzwerk von:

Anbietertyp	Gesamtzahl
Krankenhäuser	67,000+
Ärzte	106,000+
Apotheken	64,000+

Fortschrittliche digitale Gesundheitsplattformen

Zur digitalen Infrastruktur gehören:

• Proprietäre Telegesundheitsplattformen
• KI-gestützte Gesundheitsüberwachungssysteme
• Mobile Gesundheitsanwendungen

Digitale Plattformmetrik	Statistik 2024
Jährliche digitale Gesundheitsinteraktionen	42 Millionen+
Benutzer mobiler Apps	8,3 Millionen

Umfangreiche Datenanalysefunktionen

Ressourcen zur Datenanalyse:

• Proprietäres Data Warehouse für das Gesundheitswesen
• Algorithmen für maschinelles Lernen
• Prädiktive Gesundheitsmodellierungssysteme

Datenanalysemetrik	2024-Fähigkeiten
Verarbeitete Krankenakten	290 Millionen+
Jährliche Datenverarbeitungskapazität	1,2 Petabyte

Starke Finanzinfrastruktur

Finanzielle Mittel ab 2024:

Finanzkennzahl	Betrag
Gesamtumsatz	142,5 Milliarden US-Dollar
Operativer Cashflow	8,3 Milliarden US-Dollar
Gesamtvermögen	186,7 Milliarden US-Dollar

Erfahrene Gesundheitsmanagementteams

Managementmetrik	Statistik 2024
Gesamtzahl der Mitarbeiter	116,000+
Durchschnittliche Managementerfahrung	17,5 Jahre

Elevance Health Inc. (ELV) – Geschäftsmodell: Wertversprechen

Umfassender Krankenversicherungsschutz

Im vierten Quartal 2023 bietet Elevance Health Inc. 47,8 Millionen Mitgliedern Krankenversicherungsschutz in den Segmenten Commercial, Medicare und Medicaid. Die gesamten Krankenversicherungsprämien des Unternehmens beliefen sich im Jahr 2023 auf einen Jahresumsatz von 117,4 Milliarden US-Dollar.

Versicherungssegment	Anzahl der Mitglieder	Marktanteil
Kommerziell	24,3 Millionen	16.2%
Medicare	12,5 Millionen	11.7%
Medicaid	11 Millionen	9.5%

Personalisierte Gesundheitslösungen

Elevance Health investiert jährlich 782 Millionen US-Dollar in personalisierte Gesundheitstechnologie und Datenanalyseplattformen.

• KI-gesteuerte prädiktive Gesundheitsrisikobewertung
• Maßgeschneiderte Pflegemanagementprogramme
• Individuelle Behandlungsempfehlungen

Optionen für digitale und telemedizinische Dienste

Digitale Gesundheitsdienste machen 22,4 % der gesamten Patienteninteraktionen aus, wobei im Jahr 2023 8,3 Millionen Telegesundheitskonsultationen durchgeführt wurden.

Digitaler Gesundheitsdienst	Jährliche Nutzung
Virtuelle Arztkonsultationen	5,6 Millionen
Telemedizin für psychische Gesundheit	1,7 Millionen
Management chronischer Krankheiten	1 Million

Kostengünstiges medizinisches Versorgungsmanagement

Elevance Health senkt die Gesundheitskosten durch fortschrittliche Pflegemanagementstrategien um 14,6 % und spart seinen Mitgliedern im Jahr 2023 etwa 3,2 Milliarden US-Dollar.

Integrierte Wellness- und Präventionsprogramme

Das Unternehmen betreibt 672 Wellnesszentren und investiert 456 Millionen US-Dollar in Präventionsinitiativen, was 35,6 % seiner gesamten Mitgliederbasis abdeckt.

• Jährliche Gesundheitsuntersuchungen
• Programme zur Prävention chronischer Krankheiten
• Interventionen zum Lebensstilmanagement

Elevance Health Inc. (ELV) – Geschäftsmodell: Kundenbeziehungen

Online-Mitgliederportale

Ab 2024 unterhält Elevance Health ein Online-Mitgliederportal mit den folgenden Schlüsselkennzahlen:

Portalmetrik	Spezifische Daten
Gesamtzahl der digitalen Mitglieder	4,6 Millionen aktive Benutzer
Monatliche Portal-Login-Rate	62 % der registrierten Mitglieder
Self-Service-Transaktionen	3,2 Millionen monatliche digitale Transaktionen

Kundendienstzentren

Elevance Health betreibt eine Kundensupport-Infrastruktur mit diesen Spezifikationen:

• 24/7-Kundendienstzentren
• Durchschnittliche Reaktionszeit im Callcenter: 2,7 Minuten
• Jährliches Kundensupportvolumen: 12,4 Millionen Interaktionen
• Multi-Channel-Support einschließlich Telefon, E-Mail und Chat

Mobile App-Engagement-Plattformen

Kennzahlen zum Engagement in mobilen Anwendungen für 2024:

Metrik für mobile Apps	Spezifische Daten
Gesamtzahl der Downloads mobiler Apps	3,8 Millionen Downloads
Monatlich aktive Benutzer	2,1 Millionen Nutzer
Durchschnittliche App-Sitzungsdauer	7,4 Minuten pro Sitzung

Personalisierte Tools für das Gesundheitsmanagement

Funktionen der personalisierten Gesundheitsmanagementplattform:

• KI-gesteuerte Gesundheitsrisikobewertungen
• Personalisierte Wellness-Empfehlungen
• Programme zur Behandlung chronischer Erkrankungen
• Digitale Gesundheitscoaching-Dienste

Regelmäßige Kommunikations- und Gesundheitsaktualisierungen

Leistungskennzahlen für Kommunikationskanäle:

Kommunikationskanal	Monatliches Engagement
E-Mail-Gesundheitsnewsletter	2,9 Millionen Abonnenten
SMS-Gesundheitswarnungen	1,7 Millionen aktive Empfänger
Personalisierte Gesundheitsempfehlungen	3,4 Millionen gezielte Mitteilungen

Elevance Health Inc. (ELV) – Geschäftsmodell: Kanäle

Digitale Plattformen und mobile Anwendungen

Elevance Health betreibt die Mobile Anwendung von Sydney Health, die ab 2023 über 12 Millionen Mitglieder betreut. Die digitale Plattform verarbeitet etwa 3,5 Millionen monatliche digitale Interaktionen für Gesundheitsdienste.

Digitaler Kanal	Monatlich aktive Benutzer	Schlüsselfunktionen
Sydney Health App	12 Millionen	Schadensprüfung, Anbietersuche, digitaler Personalausweis
Webportal	8,2 Millionen	Leistungsverwaltung, Anmeldung

Versicherungsmakler und -agenten

Elevance Health unterhält ein Netzwerk von 3.700 lizenzierte Versicherungsmakler in 14 Bundesstaaten und erwirtschaftet über indirekte Vertriebskanäle jährliche Prämieneinnahmen in Höhe von etwa 2,3 Milliarden US-Dollar.

Direktvertriebsteams

Das Unternehmen beschäftigt 1.200 engagierte Vertriebsmitarbeiter Zielgruppe sind Einzel- und Gruppenmärkte mit einem durchschnittlichen jährlichen Umsatzvolumen von 187 Millionen US-Dollar pro Vertriebsteam.

Verkaufskategorie	Teamgröße	Jahresumsatz
Individueller Markt	650 Vertreter	1,1 Milliarden US-Dollar
Gruppenmarkt	550 Vertreter	1,2 Milliarden US-Dollar

Anmeldeprogramme für Arbeitgebergruppen

Elevance Health dient über 46.000 Arbeitgebergruppen, die rund 16,5 Millionen Mitglieder über betriebliche Krankenversicherungspläne abdeckt.

• Kleinunternehmenssegment: 28.000 Arbeitgeber
• Mittleres Marktsegment: 12.500 Arbeitgeber
• Großunternehmenssegment: 5.500 Arbeitgeber

Online-Marketing und Webportale

Das Unternehmen investiert jährlich 124 Millionen US-Dollar in digitales Marketing und generiert so Umsatz 2,6 Millionen Online-Conversions über alle Produktlinien im Gesundheitswesen hinweg.

Marketingkanal	Jährliche Investition	Conversion-Rate
Bezahlte digitale Werbung	78 Millionen Dollar	1,4 Millionen Conversions
Organisches Webmarketing	46 Millionen Dollar	1,2 Millionen Conversions

Elevance Health Inc. (ELV) – Geschäftsmodell: Kundensegmente

Individuelle Krankenversicherungskunden

Im Jahr 2023 betreut Elevance Health rund 47,8 Millionen einzelne Krankenversicherte in mehreren Bundesstaaten. Die Aufschlüsselung des Kundenstamms umfasst:

Altersgruppe	Anzahl der Verbraucher	Prozentsatz
18-34 Jahre	12,3 Millionen	25.7%
35-54 Jahre	18,5 Millionen	38.7%
55+ Jahre	17 Millionen	35.6%

Unternehmens- und Arbeitgebergruppen

Elevance Health bietet Krankenversicherungsschutz für 16,2 Millionen Mitarbeiter in verschiedenen Branchen.

Industriesektor	Anzahl der abgedeckten Mitarbeiter
Technologie	3,4 Millionen
Herstellung	2,9 Millionen
Gesundheitswesen	2,7 Millionen
Einzelhandel	2,5 Millionen
Andere Sektoren	4,7 Millionen

Medicare- und Medicaid-Begünstigte

Gesamtzahl der Medicare- und Medicaid-Leistungsempfänger: 14,6 Millionen

• Medicare Advantage-Registrierte: 8,3 Millionen
• Medicaid Managed Care-Teilnehmer: 6,3 Millionen

Kleine bis mittlere Unternehmen

Elevance Health deckt 1,2 Millionen kleine und mittlere Unternehmen in den Vereinigten Staaten ab.

Unternehmensgröße	Anzahl der Unternehmen	Durchschnittliche Mitarbeiter pro Unternehmen
Kleine Unternehmen (10-50 Mitarbeiter)	780,000	25
Mittelständische Unternehmen (51-500 Mitarbeiter)	420,000	150

Selbstständige Fachkräfte

Elevance Health betreut 2,1 Millionen Selbstständige in verschiedenen Branchen.

• Freiberufler: 1,2 Millionen
• Unabhängige Auftragnehmer: 580.000
• Kleinunternehmer: 320.000

Elevance Health Inc. (ELV) – Geschäftsmodell: Kostenstruktur

Wartung des Netzwerks von Gesundheitsdienstleistern

Im Jahr 2023 meldete Elevance Health Inc. Netzwerkwartungskosten in Höhe von 4,2 Milliarden US-Dollar. Die Kostenaufschlüsselung umfasst:

Ausgabenkategorie	Betrag (in Millionen US-Dollar)
Verhandlungen über Anbieterverträge	1,350
Netzwerk-Authentifizierung	620
Anbieter-Performance-Management	780

Kosten für die Schadensbearbeitung

Die Schadenbearbeitungskosten für Elevance Health beliefen sich im Jahr 2023 auf insgesamt 2,8 Milliarden US-Dollar.

• Infrastruktur für die digitale Schadenbearbeitung: 890 Millionen US-Dollar
• Manuelle Schadensprüfung: 650 Millionen US-Dollar
• Systeme zur Erkennung von Schadensersatzansprüchen: 420 Millionen US-Dollar

Technologie und digitale Infrastruktur

Die Technologieinvestitionen für 2023 erreichten 1,6 Milliarden US-Dollar.

Technologiesegment	Ausgaben (in Millionen US-Dollar)
Cloud-Computing	520
Cybersicherheit	340
Digitale Gesundheitsplattformen	450

Verwaltungs- und Betriebskosten

Die Verwaltungskosten beliefen sich im Jahr 2023 auf 3,5 Milliarden US-Dollar.

• Unternehmensgemeinkosten: 1,2 Milliarden US-Dollar
• Personal: 620 Millionen US-Dollar
• Compliance und regulatorische Berichterstattung: 540 Millionen US-Dollar

Aufwendungen für Marketing und Kundenakquise

Die Marketingausgaben für 2023 beliefen sich auf insgesamt 1,1 Milliarden US-Dollar.

Marketingkanal	Ausgaben (in Millionen US-Dollar)
Digitales Marketing	420
Traditionelle Werbung	350
Kosten für Vertriebsmitarbeiter	330

Elevance Health Inc. (ELV) – Geschäftsmodell: Einnahmequellen

Krankenversicherungsprämien

Gesamteinnahmen aus Krankenversicherungsprämien für Elevance Health Inc. im Jahr 2022: 117,7 Milliarden US-Dollar

Segment	Prämieneinnahmen (2022)
Gewerbliche Versicherung	48,3 Milliarden US-Dollar
Medicare	35,6 Milliarden US-Dollar
Medicaid	33,8 Milliarden US-Dollar

Erstattungen für staatliche Gesundheitsprogramme

Gesamte staatliche Gesundheitserstattungen im Jahr 2022: 69,4 Milliarden US-Dollar

• Medicare Advantage-Erstattungen: 42,1 Milliarden US-Dollar
• Medicaid-Managed-Care-Erstattungen: 27,3 Milliarden US-Dollar

Gebühren für das Wellness-Programm

Einnahmen aus Wellnessprogrammen im Jahr 2022: 1,2 Milliarden US-Dollar

Gebühren für digitale Gesundheitsdienste

Umsatz mit digitalen Gesundheitsdiensten im Jahr 2022: 780 Millionen US-Dollar

Digitaler Diensttyp	Einnahmen
Telegesundheitsdienste	420 Millionen Dollar
Fernüberwachung von Patienten	210 Millionen Dollar
Digitales Pflegemanagement	150 Millionen Dollar

Einnahmen aus dem Apotheken-Benefit-Management

Einnahmen aus der Verwaltung von Apothekenleistungen im Jahr 2022: 24,6 Milliarden US-Dollar

• Bearbeitung von Ansprüchen auf verschreibungspflichtige Medikamente: 18,3 Milliarden US-Dollar
• Verwaltung des Apothekennetzwerks: 4,2 Milliarden US-Dollar
• Arzneimittelpreise und Rabattdienste: 2,1 Milliarden US-Dollar

Elevance Health Inc. (ELV) - Canvas Business Model: Value Propositions

You're looking at the core promises Elevance Health Inc. (ELV) makes to its customers, which are the foundation of their business model right now. It's all about integration and driving value across the entire care journey.

Whole-health model integrating medical, pharmacy, and behavioral care.

Elevance Health Inc. is executing on a strategy that ties together the different parts of healthcare delivery, making the Carelon segment central to this. For the third quarter of 2025, Carelon, which houses pharmacy and services, posted operating revenue of $18.3 billion, a year-over-year increase of 33 percent. This integration is meant to improve outcomes and reduce overall system costs. The company serves a massive base, with Carelon serving 97.3 million consumers in the second quarter of 2025. Executives have specifically called home health services critical to advancing this whole health strategy.

Lowering the total cost of care through value-based arrangements.

The push to lower the total cost of care is heavily reliant on shifting payment models. Value-based contracts, which pay for improved health outcomes rather than just the volume of services, account for approximately 63% of Elevance Health Inc.'s medical spend across all health product lines. The company is focused on scaling its enterprise flywheel through Carelon's differentiated value-based care solutions. The full-year 2025 benefit expense ratio guidance remains approximately 90.0%.

Simplified, personalized member experience via digital tools and patient advocacy.

Simplifying access is a key value proposition, supported by technology investments. Elevance Health Inc. is making incremental investments, amounting to several hundred million dollars, to advance its AI and digital strategy. By the end of 2025, the goal is for more than 10 million members to have access to their AI-enabled virtual assistant. The company is using AI-enabled digital solutions to simplify access and improve outcomes for members.

Comprehensive government plans with $0 premium options for Medicare Advantage.

Affordability in government plans, especially Medicare Advantage (MA), is a major draw. For the 2025 plan year, 9 out of 10 of Elevance Health Inc.'s affiliated MA plans feature a $0 premium. Furthermore, nearly all of these MA plans offer $0 copays for visits to Primary Care Providers. Growth in MA membership was a driver for the Health Benefits segment revenue in the third quarter of 2025.

Integrated specialty services (e.g., home health, palliative care) via Carelon.

Carelon is the vehicle for scaling integrated specialty and home-based services. Its Q3 2025 operating revenue hit $18.3 billion, showing a 33 percent increase year-over-year, which was fueled by recent acquisitions in home health and pharmacy services. The Health Services part of Carelon is targeted for a high teens to low twenties revenue Compound Annual Growth Rate.

Here are some key financial and operational metrics supporting these value propositions as of late 2025:

Metric Category	Specific Data Point	Amount/Value	Reporting Period/Context
Top Line Scale	Consolidated Operating Revenue	$50.1 billion	3Q 2025
Health Benefits Scale	Health Benefits Segment Operating Revenue	$42.2 billion	3Q 2025
Carelon Scale	Carelon Segment Operating Revenue	$18.3 billion	3Q 2025
Cost Management Target	Full-Year 2025 Benefit Expense Ratio Guidance	Approximately 90.0%	FY 2025 Guidance
Membership Scale	Total Medical Membership	Approximately 45.4 million	September 30, 2025
MA Affordability	Medicare Advantage Plans with $0 Premium	9 out of 10	2025 Plan Year
Digital Reach	Projected Members with AI Virtual Assistant Access	More than 10 million	Year-End 2025

The focus on integrating these components is clear when you look at the segment performance:

• CarelonRx product revenue growth contributed to a 34 percent increase in Carelon operating gain for the first quarter of 2025.
• The Health Benefits segment saw its operating gain contract to 1.4% margin in 3Q 2025, despite a 10.4% revenue increase.
• Elevance Health Inc. reaffirmed its full-year 2025 adjusted diluted Earnings Per Share guidance at approximately $30.00.
• The company paid a quarterly dividend of $1.71 per share in Q3 2025.

Elevance Health Inc. (ELV) - Canvas Business Model: Customer Relationships

You're looking at how Elevance Health Inc. (ELV) keeps its massive member base engaged and satisfied as of late 2025. It's all about tailored support, honestly, especially given the scale; they serve approximately 45.4 million medical members as of the third quarter of 2025.

Dedicated patient advocacy solutions are a big part of this. Take the My Health Advocate model; their team handled over 800,000 calls in 2024 alone, showing a significant commitment to direct member interaction. This high-touch approach translates into real health improvements for specific groups. For instance, one program that matches associates with members managing both physical and mental health conditions saw participants experience an 8% reduction in hospital admissions and a remarkable 43% decrease in ER visits. That's the kind of tangible outcome they push for.

For complex populations, like those who are dually eligible for Medicare and Medicaid, the support is designed to be proactive and simple. Elevance Health is the #2 nationally in the SNP market, and they provide specialized Dual Eligible Special Needs Plan (D-SNP) support across 22 states. They aim to offer these members a single card for extra benefits, which simplifies things defintely. Here's a quick look at some of the scale and focus areas as of mid-to-late 2025:

Metric Category	Specific Data Point	Value/Amount
Total Medical Membership (Q3 2025)	Reported Medical Membership	45.4 million
Medicare Advantage (MA) Focus	Projected 2025 MA Membership Growth Target	At least 7%
Complex Care Support	States with D-SNP Offerings	22 states
Advocacy Volume (2024)	Calls Handled by My Health Advocate Team	800,000
Market Presence	Total Medicare Markets	25 markets

The push for automated and real-time digital interactions centers on the HealthOS platform. Elevance Health is actively expanding digital innovation, which includes leveraging HealthOS and AI-enabled clinical support to personalize the member experience. This digital layer works alongside the human touchpoints to make interactions smoother.

When it comes to large Employer Group clients, the relationship is managed through dedicated account management and consulting. This segment saw gains, and the company secured a key group Medicare Advantage contract with a long-term commercial partner, showing deep, established relationships are key to growth in that area. You see this focus on existing relationships across the board, really.

Finance: review the Q4 2025 projected impact of the 150,000 MA member exits on year-end enrollment by next Tuesday.

Elevance Health Inc. (ELV) - Canvas Business Model: Channels

You're looking at how Elevance Health Inc. actually gets its products and services into the hands of its members and clients. It's not just one path; it's a complex web, which is smart given their scale of over 45.369 million medical members as of September 2025. Here's the breakdown of the main routes they use to reach the market.

Affiliated Health Plans: Anthem Blue Cross and Blue Shield and Wellpoint

This is the bedrock of their commercial business. Elevance Health maintains brand consistency through its affiliated plans, prominently using the Anthem Blue Cross and Blue Shield name across 14 states where they operate as the licensee for the Blue Cross Blue Shield Association. The Health Benefits segment, which houses these plans, reported operating revenue of $42.2 billion for the third quarter of 2025.

The reach through these core brands is substantial, though membership can fluctuate; for instance, total medical membership was approximately 45.8 million as of March 31, 2025. Their Medicare Advantage membership growth is a key driver here, with executives expressing confidence in growth targets of at least 7% for 2025.

Direct Sales Force and Broker/Agent Networks for Individual and MA Enrollment

For the Individual and Medicare Advantage (MA) enrollment, Elevance Health relies heavily on external networks alongside any internal sales teams. For individual consumers, plans are accessible via brokers. The strategy for MA is targeted, focusing on favorable growth opportunities, especially in HMO and Dual Special Needs Plan (D-SNP) segments, following optimization of their footprint which included exiting approximately 150K members in some markets. They are also working to improve their Star Ratings, with 55% of MA members expected to be in 4+ Star contracts for the 2027 plan year.

Digital Platforms and Mobile Applications for Member Self-Service

Digital is definitely a major focus for member interaction and service delivery. Elevance Health is pushing hard to get members to use their digital tools, aiming for $1 billion in annual revenue from digital solutions by 2025. The Sydney Health platform, which includes the mobile app, is central to this. Traffic to the Sydney Health Platform saw a 10% increase from 2023 to 2024, with mobile app usage specifically jumping by 25% in that same period.

A key feature rolled out is the AI-driven Virtual Assistant, integrated into Sydney Health. By the end of 2025, more than 10 million members are expected to have access to this assistant. Early pilot results showed nearly 9 out of 10 users found the answers they needed. Currently, the Virtual Assistant is available to approximately 22 million members in commercial health plans, with expansion planned for Medicare members in 2026. It's a defintely a big investment in simplifying the member journey.

Direct Marketing (Email, Telemarketing) to Employers and Individual Consumers

While specific direct marketing spend or response rates aren't public, the overall strategy for employer groups involves offering risk-based and fee-based solutions through direct sales channels. The company's ability to secure a key client for a group Medicare Advantage contract, which was a long-term commercial partner, shows the effectiveness of deep, direct relationship management in driving enrollment growth.

Direct Contracts with State and Federal Governments for Public Programs

Government programs, including Medicaid and Medicare, are massive revenue drivers. For context, U.S. government agencies accounted for approximately 31% of total consolidated revenues in 2024. The Health Benefits segment revenue in Q3 2025 was $42.2 billion, which includes these government lines of business. However, this channel faces headwinds; Medicaid performance was expected to be modestly negative for the full year 2025, and the company expects a decline of at least 125 basis points in Medicaid margins in 2026 due to utilization trends.

Here's a quick look at some of the scale metrics across the enterprise that these channels feed into:

Metric	Value (As of Late 2025 Data)	Source Context
Total Medical Membership (Sep 2025)	45,369.00K members	Q3 2025 Reporting
Health Benefits Segment Q3 2025 Revenue	$42.2 billion	Q3 2025 Reporting
Digital Solutions Revenue Target for 2025	$1 billion	Strategic Goal
Virtual Assistant Users (Commercial Plans)	Approx. 22 million members	As of late 2025
BCBS License States	14 states	Operational Footprint

The company returned $3.3 billion of capital to shareholders year-to-date as of Q3 2025, showing the financial output generated through these various channels.

Elevance Health Inc. (ELV) - Canvas Business Model: Customer Segments

You're looking at the core groups Elevance Health Inc. (ELV) serves across its insurance and services arms as of late 2025. The customer base is massive, spanning government programs and private employers, plus external clients for their Carelon division.

As of the third quarter of 2025, Elevance Health served approximately 45.4 million medical members in total. This is down slightly from the 45.8 million reported at the end of the first quarter of 2025.

Here is a breakdown of the key medical membership categories, largely based on the second quarter of 2025 figures, which show the composition of the overall book of business:

Customer Segment Category	Membership Count (in thousands)	Data Point Source Quarter
Commercial Members	27,100	Q2 2025
Medicaid Managed Care Members	8,700	Q2 2025
Medicare Advantage Members	2,300	Q2 2025
Individual Members (ACA Exchange)	1,300	Q2 2025

The company's strategy involves balancing these segments, though recent trends show pressure in certain areas. For instance, the company cited membership decline in Medicaid and attrition in the individual market in the second quarter of 2025.

Employer Group (Commercial) members

This group is split between risk-based and fee-based plans. The commercial membership base stood at 27.1 million as of the second quarter of 2025. Growth in the risk-based portion helped offset a decline in the fee-based membership due to a known customer transition in the first quarter of 2025.

Medicare Advantage beneficiaries

Elevance Health reported 2.3 million Medicare Advantage members as of the second quarter of 2025. This is slightly above the stated target range of 2.2-2.25 million members for 2025, reflecting a projected growth of 7%-9% for the year from the end of 2024. The company is focusing on Dual Special Needs Plans (DSNP) within this segment, which typically carry high margins.

Medicaid managed care beneficiaries in multiple states

As of the second quarter of 2025, Elevance Health covered 8.7 million Medicaid members across its operating states. This segment experienced membership attrition in early 2025, which contributed to overall membership declines in the first half of the year. The company is actively engaged in rate discussions to align with elevated acuity levels observed in this population.

Individual members through the ACA Health Insurance Exchange

This segment had 1.3 million members as of the second quarter of 2025. The company noted attrition in this market in the second quarter of 2025, which was partially driven by members being removed due to an inability to pay premiums following resumed eligibility checks.

External health plans and providers utilizing Carelon services

Carelon, which includes CarelonRx and Carelon Services, serves a massive external client base beyond the direct medical membership. In the second quarter of 2025, Carelon served 97.3 million consumers. The segment's operating revenue reached $18.3 billion in the third quarter of 2025, showing significant growth driven by acquisitions and scaling of risk-based capabilities in Carelon Services.

The scale of Carelon's reach is evident in its platform support:

• Patient advocacy solutions supported over 6 million members with a 95% satisfaction rate in early 2025.
• The HealthOS digital platform supported over 88,000 care providers as of Q1 2025.
• Carelon Services launched new post-acute and behavioral health contracts.

The overall enterprise serves over 110 million consumers across its entire portfolio of medical, pharmacy, and services solutions as of the first quarter of 2025.

Finance: draft 13-week cash view by Friday.

Elevance Health Inc. (ELV) - Canvas Business Model: Cost Structure

You're looking at the core expenses that drive Elevance Health Inc.'s financial performance as of late 2025. Honestly, for an insurer, the cost side is dominated by one massive line item, but the growth in the services division brings new cost dynamics into play.

Benefit Expense (Medical Loss Ratio)

The single largest cost component is the Benefit Expense, which is essentially what Elevance Health pays out for member medical claims. For the full Fiscal Year 2025, the company reaffirmed guidance targeting a benefit expense ratio of approximately 90.0%. This target reflects the ongoing pressure from utilization trends across the book of business. Looking at the most recent reported quarter, the third quarter of 2025, the actual benefit expense ratio was 91.3%, which was an increase of 180 basis points year-over-year, driven by cost trends primarily in the Medicare business due to seasonality in Part D benefits associated with the Inflation Reduction Act changes. To give you a sense of the trend, the second quarter of 2025 saw an MLR of 88.9%, and the first quarter of 2025 was 86.4%.

Here's a quick look at how that key metric has moved:

Metric	Period Ended	Reported Percentage
FY 2025 Guidance (Target)	Full Year 2025	90.0%
Benefit Expense Ratio	Q3 2025	91.3%
Medical Loss Ratio (MLR)	Q2 2025	88.9%
Benefit Expense Ratio	Q1 2025	86.4%

Administrative and Operating Expenses

These are the costs of running the business outside of direct medical claims. For the third quarter of 2025, the operating expense ratio was reported at 10.5%, while the adjusted operating expense ratio was 10.4%. This compares to the first quarter of 2025, where the operating expense ratio was 10.9%. The slight uptick in the adjusted ratio in Q3 2025, up 100 basis points year-over-year, reflects specific spending choices.

Costs of Products Sold (CarelonRx Segment Scale)

Costs associated with the CarelonRx pharmacy segment are embedded within the overall structure, particularly impacting the Cost of Products Sold line item when calculating operating gain. While the specific Cost of Products Sold dollar amount isn't broken out separately from operating gain calculations, the scale of the Carelon division gives you an idea of the associated costs. Carelon, which includes pharmacy and services, posted operating revenue of $18.3 billion in Q3 2025, up 33% year-over-year. In Q2 2025, Carelon revenue was $18.1 billion, and in Q1 2025, it was $16.7 billion. These figures show the significant volume of product and service costs Elevance Health is managing through this segment.

Technology and AI Investment Costs

You see the impact of technology spending reflected in the operating expenses. The Q3 2025 adjusted operating expense ratio increase was attributed to targeted investments. Specifically, management cited accelerating technology adoption and scaling Carelon's capabilities. Furthermore, planning for 2026 includes several hundred million of incremental investments specifically earmarked for AI initiatives, alongside other growth areas.

Acquisition and Integration Costs

The push into home health and services brings significant upfront costs related to M&A activity. The acquisition of the home health company CareBridge was reportedly valued at $2.7 billion. Elevance Health also bolstered in-home services with the January 2024 acquisition of Paragon Healthcare, an infusion services company, which sources estimated cost more than $1 billion. These recent acquisitions contributed to the 33% year-over-year increase in Carelon's operating revenue in Q3 2025.

Key drivers influencing the expense base include:

• The $2.7 billion acquisition of CareBridge, which is being integrated into Carelon.
• The integration of Paragon Healthcare, with an estimated cost exceeding $1 billion.
• Targeted platform investments within Carelon to support growth and scaling of pharmacy assets.
• Incremental planned investments in AI for 2026, estimated in the hundreds of millions.

Finance: draft 13-week cash view by Friday.

Elevance Health Inc. (ELV) - Canvas Business Model: Revenue Streams

You're looking at how Elevance Health Inc. (ELV) brings in the money, and right now, it's heavily weighted toward managing risk through insurance and expanding its services arm. The revenue streams are clearly segmented, reflecting the dual nature of the business: paying for care versus providing care and services.

The core of the revenue generation comes from the Health Benefits segment, which covers the premiums you collect for assuming the financial risk of members' healthcare needs. For the third quarter of 2025, this segment brought in operating revenue of \$42.2 billion. This figure reflects the scale of their Commercial, Medicare, and Medicaid plan participation.

The growth in that core segment was driven by a few key factors as of Q3 2025:

• Higher premium yields across the board.
• Growth in Medicare Advantage membership, which surged 9.7% year-over-year to 2.25 million members.
• Recently closed acquisitions.

Offsetting some of that growth was ongoing Medicaid reverification, leading to membership attrition in that specific area.

The second major pillar is the Carelon division, which is Elevance Health Inc.'s health services arm, focusing on pharmacy benefits (CarelonRx), behavioral health, and complex care management. In Q3 2025, Carelon's operating revenue hit \$18.3 billion, representing a 33% year-over-year increase. This rapid growth is fueled by scaling risk-based solutions and acquisitions in areas like home health and pharmacy services.

Here's a quick breakdown of the primary revenue components based on the latest reported segment data:

Revenue Source Category	Q3 2025 Operating Revenue Amount	Year-over-Year Growth (Q3 2025)
Health Benefits Premiums (Core Insurance)	\$42.2 billion	10%
Carelon Services (PBM, Specialty, etc.)	\$18.3 billion	33%

You should also factor in the revenue derived from Fee-Based Administrative Services (ASO) for self-funded employers, which is part of the Health Benefits segment but reported separately from the risk-based premiums. While the segment includes this business, specific ASO dollar amounts aren't broken out in the headline Q3 2025 figures, so we look at the overall segment performance for context.

Finally, the company generates income from its financial assets. Investment income from reserves and float is a material component of the overall financial picture. For instance, Q3 2025 results showed strong growth in net investment income contributing to adjusted earnings.

Looking ahead, management's expectations for the full year 2025 provide a forward-looking metric on overall profitability derived from these streams. The reaffirmed guidance for full-year 2025 adjusted diluted EPS is approximately \$30.00 per share.

To be clear, the \$30.00 adjusted EPS guidance excludes approximately \$5.90 per diluted share of net unfavorable items, meaning the GAAP EPS guidance is lower, around \$24.10 or \$24.70, depending on the specific reaffirmation date referenced.

The overall revenue picture for Q3 2025 saw consolidated operating revenue reach \$50.1 billion, a 12% increase year-over-year.

Finance: draft 13-week cash view by Friday.