Elevance Health Inc. (ELV): Lienzo del Modelo de Negocio [Actualizado en Ene-2025]

En el panorama dinámico del seguro de salud, Elevance Health Inc. (ELV) surge como una potencia transformadora, redefiniendo cómo los estadounidenses acceden y experimentan cobertura médica. Esta compañía innovadora ha creado meticulosamente un modelo de negocio que va más allá de los seguros tradicionales, integrando tecnologías digitales de vanguardia, programas integrales de bienestar y soluciones personalizadas de atención médica. Al aprovechar estratégicamente una extensa red de asociaciones y análisis de datos avanzados, Elevance Health no solo vende un seguro, sino que están revolucionando todo el ecosistema de atención médica, lo que hace que la atención médica integral, rentable y tecnológicamente avanzada sea accesible para millones en diversos segmentos de clientes.

Elevance Health Inc. (ELV) - Modelo de negocio: asociaciones clave

Proveedores de atención médica y hospitales en todo el país

Elevance Health mantiene asociaciones con aproximadamente 106,000 médicos de atención primaria y 510,000 médicos de atención especializada a partir de 2023. La compañía tiene relaciones contractuales con más de 4,700 hospitales en todo el país.

Tipo de asociación	Número de proveedores	Área de cobertura
Médicos de atención primaria	106,000	A escala nacional
Médicos de atención especializada	510,000	A escala nacional
Hospitales	4,700	A escala nacional

Gerentes de beneficios farmacéuticos (PBMS)

Elevance Health posee Ingeniorx, uno de los PBM más grandes en los Estados Unidos, que atiende a aproximadamente 45 millones de miembros.

• Cuota de mercado de PBM: aproximadamente el 7,5% del mercado total de PBM
• Reclamaciones de prescripción procesadas anualmente: más de 1.200 millones

Tecnología y socios de soluciones de salud digital

Elevance Health colabora con múltiples socios de tecnología para mejorar las soluciones de atención médica digital.

Categoría de socio	Número de asociaciones	Área de enfoque
Plataformas de telesalud	12	Prestación de atención médica remota
AI Soluciones de atención médica	8	Análisis predictivo
Monitoreo de la salud digital	15	Compromiso del paciente

Programas de atención médica del gobierno

Elevance Health participa en múltiples programas de salud gubernamentales en diferentes estados.

• Contratos de Medicaid: activo en 19 estados
• Miembros de Medicare Advantage: más de 2.3 millones
• Total de los miembros del programa gubernamental: aproximadamente 6.5 millones

Empresas de seguros y reaseguros

Elevance Health mantiene asociaciones estratégicas con múltiples entidades de seguros y reaseguros.

Tipo de asociación	Número de socios	Cobertura de mitigación de riesgos
Compañías de reaseguros	7	Cobertura total de $ 5.2 mil millones
Socios de seguro regional	23	Nationwide Risk Compartir

Elevance Health Inc. (ELV) - Modelo de negocio: actividades clave

Seguro de salud y gestión de cobertura médica

Elevance Health gestiona la cobertura del seguro de salud para aproximadamente 47.5 millones de miembros en varios segmentos a partir de 2023. La compañía opera en 14 estados con planes integrales de cobertura médica.

Segmento de cobertura	Número de miembros
Seguro comercial	28.3 millones
Seguro médico del estado	8.9 millones
Seguro de enfermedad	10.3 millones

Procesamiento y administración de reclamos

Elevance Health procesa aproximadamente 250 millones de reclamos anuales con una tasa de eficiencia de procesamiento digital del 92%. El sistema de administración de reclamos de la compañía maneja:

• Reclamos médicos
• Reclamos de farmacia
• Reclamos dentales
• Reclamos de visión

Desarrollo de la red de atención médica

La compañía mantiene una red de 106,000 proveedores de atención médica y 6,200 hospitales en sus estados operativos. La composición de la red incluye:

Tipo de proveedor	Número
Médicos de atención primaria	48,500
Médicos especializados	57,500

Innovación de tecnología de salud digital

Elevance Health invirtió $ 782 millones en tecnologías de salud digital en 2023. Las inversiones tecnológicas clave incluyen:

• Plataformas de telemedicina
• Sistemas de monitoreo de salud impulsados ​​por IA
• Aplicaciones de salud móvil
• Integración de registros de salud electrónicos

Diseño del programa de bienestar y atención preventiva

La Compañía implementa programas de bienestar para 35.6 millones de miembros, con una inversión anual de $ 425 millones en iniciativas de atención preventiva.

Categoría de programa	Participantes anuales
Manejo de enfermedades crónicas	12.3 millones
Apoyo de salud mental	8.7 millones
Programas de fitness y nutrición	14.6 millones

Elevance Health Inc. (ELV) - Modelo de negocio: recursos clave

Extensa red de proveedores de atención médica

A partir de 2024, Elevance Health mantiene una red integral de:

Tipo de proveedor	Número total
Hospitales	67,000+
Médicos	106,000+
Farmacias	64,000+

Plataformas de salud digital avanzadas

La infraestructura digital incluye:

• Plataformas de telesalud propietarias
• Sistemas de monitoreo de salud con IA
• Aplicaciones de salud móvil

Métrica de plataforma digital	2024 estadísticas
Interacciones anuales de salud digital	42 millones+
Usuarios de aplicaciones móviles	8.3 millones

Capacidades de análisis de datos a gran escala

Recursos de análisis de datos:

• Almacén de datos de atención médica patentada
• Algoritmos de aprendizaje automático
• Sistemas de modelado de salud predictivo

Métrica de análisis de datos	Capacidades 2024
Registros de atención médica procesados	290 millones+
Capacidad de procesamiento de datos anual	1.2 petabytes

Infraestructura financiera fuerte

Recursos financieros a partir de 2024:

Métrica financiera	Cantidad
Ingresos totales	$ 142.5 mil millones
Flujo de caja operativo	$ 8.3 mil millones
Activos totales	$ 186.7 mil millones

Equipos experimentados de gestión de la salud

Métrica de gestión	2024 estadística
Total de empleados	116,000+
Experiencia de gestión promedio	17.5 años

Elevance Health Inc. (ELV) - Modelo de negocio: propuestas de valor

Cobertura de seguro de salud integral

A partir del cuarto trimestre de 2023, Elevance Health Inc. brinda cobertura de seguro de salud a 47.8 millones de miembros en segmentos comerciales, de Medicare y Medicaid. Las primas de seguro de salud total de la compañía alcanzaron los $ 117.4 mil millones en ingresos anuales para 2023.

Segmento de seguro	Número de miembros	Cuota de mercado
Comercial	24.3 millones	16.2%
Seguro médico del estado	12.5 millones	11.7%
Seguro de enfermedad	11 millones	9.5%

Soluciones de atención médica personalizadas

Elevance Health invierte $ 782 millones anuales en plataformas personalizadas de tecnología de salud y análisis de datos.

• Evaluación de riesgo de salud predictiva impulsada por la IA
• Programas de gestión de atención personalizados
• Recomendaciones de tratamiento individualizadas

Opciones de servicio digital y de telesalud

Los servicios de salud digital representan el 22.4% de las interacciones totales del paciente, con 8.3 millones de consultas de telesalud realizadas en 2023.

Servicio de salud digital	Utilización anual
Consultas de médico virtual	5.6 millones
Telealth de salud mental	1.7 millones
Manejo de enfermedades crónicas	1 millón

Gestión rentable de atención médica

Elevance Health reduce los costos de atención médica en un 14,6% a través de estrategias avanzadas de gestión de atención, ahorrando aproximadamente $ 3.2 mil millones para los miembros en 2023.

Programas integrados de bienestar y atención preventiva

La compañía opera 672 centros de bienestar e invierte $ 456 millones en iniciativas de atención preventiva, que cubre el 35.6% de su base de miembros totales.

• Seculaciones de salud anuales
• Programas de prevención de enfermedades crónicas
• Intervenciones de gestión del estilo de vida

Elevance Health Inc. (ELV) - Modelo de negocios: relaciones con los clientes

Portales de miembros en línea

A partir de 2024, Elevance Health mantiene un portal de miembros en línea con las siguientes métricas clave:

Métrico de portal	Datos específicos
Total de miembros digitales	4.6 millones de usuarios activos
Tasa de inicio de sesión de portal mensual	62% de los miembros registrados
Transacciones de autoservicio	3.2 millones de transacciones digitales mensuales

Centros de apoyo al cliente

Elevance Health opera la infraestructura de atención al cliente con estas especificaciones:

• Centros de atención al cliente 24/7
• Tiempo de respuesta promedio del centro de llamadas: 2.7 minutos
• Volumen anual de atención al cliente: 12.4 millones de interacciones
• Soporte multicanal que incluye teléfono, correo electrónico y chat.

Plataformas de compromiso de aplicaciones móviles

Métricas de participación de aplicaciones móviles para 2024:

Módulo de aplicación móvil	Datos específicos
Descargas totales de aplicaciones móviles	3.8 millones de descargas
Usuarios activos mensuales	2.1 millones de usuarios
Duración promedio de la sesión de la aplicación	7.4 minutos por sesión

Herramientas personalizadas de gestión de la salud

Capacidades personalizadas de la plataforma de gestión de la salud:

• Evaluaciones de riesgo para la salud impulsadas por la IA
• Recomendaciones de bienestar personalizadas
• Programas de gestión de condiciones crónicas
• Servicios de coaching de salud digital

Actualizaciones regulares de comunicación y salud

Métricas de rendimiento del canal de comunicación:

Canal de comunicación	Compromiso mensual
Boletines de salud por correo electrónico	2.9 millones de suscriptores
Alertas de salud de SMS	1.7 millones de destinatarios activos
Recomendaciones de salud personalizadas	3.4 millones de comunicaciones dirigidas

Elevance Health Inc. (ELV) - Modelo de negocio: canales

Plataformas digitales y aplicaciones móviles

Elevance Health opera el Aplicación móvil de Sydney Health, que sirve a más de 12 millones de miembros a partir de 2023. La plataforma digital procesa aproximadamente 3.5 millones de interacciones digitales mensuales para los servicios de atención médica.

Canal digital	Usuarios activos mensuales	Funciones clave
Aplicación de salud de Sydney	12 millones	Revisión de reclamos, búsqueda de proveedores, tarjeta de identificación digital
Portal web	8.2 millones	Gestión de beneficios, inscripción

Corredores de seguro y agentes

Elevance Health mantiene una red de 3.700 corredores de seguro con licencia En 14 estados, generando aproximadamente $ 2.3 mil millones en ingresos premium anuales a través de canales de ventas indirectas.

Equipos de ventas directos

La empresa emplea 1.200 representantes de ventas dedicados Dirigido a los mercados individuales y grupales, con un volumen de ventas anual promedio de $ 187 millones por equipo de ventas.

Categoría de ventas	Tamaño del equipo	Ingresos anuales
Mercado individual	650 representantes	$ 1.1 mil millones
Mercado grupal	550 representantes	$ 1.2 mil millones

Programas de inscripción al grupo de empleadores

Elevance Health sirve Más de 46,000 grupos de empleadores, cubriendo aproximadamente 16.5 millones de miembros a través de planes de atención médica corporativa.

• Segmento de pequeñas empresas: 28,000 empleadores
• Segmento del mercado medio: 12,500 empleadores
• Gran segmento empresarial: 5.500 empleadores

Marketing en línea y portales web

La compañía invierte $ 124 millones anuales en marketing digital, generando 2.6 millones de conversiones en línea a través de líneas de productos de atención médica.

Canal de marketing	Inversión anual	Tasa de conversión
Publicidad digital pagada	$ 78 millones	1,4 millones de conversiones
Marketing web orgánico	$ 46 millones	1,2 millones de conversiones

Elevance Health Inc. (ELV) - Modelo de negocio: segmentos de clientes

Consumidores individuales de seguros de salud

A partir de 2023, Elevance Health atiende a aproximadamente 47.8 millones de consumidores de seguros de salud individuales en múltiples estados. El desglose de la base de clientes incluye:

Grupo de edad	Número de consumidores	Porcentaje
18-34 años	12.3 millones	25.7%
35-54 años	18.5 millones	38.7%
55+ años	17 millones	35.6%

Grupos corporativos y de empleadores

Elevance Health brinda cobertura de seguro de salud a 16.2 millones de empleados en varias industrias.

Sector industrial	Número de empleados cubiertos
Tecnología	3.4 millones
Fabricación	2.9 millones
Cuidado de la salud	2.7 millones
Minorista	2.5 millones
Otros sectores	4.7 millones

Beneficiarios de Medicare y Medicaid

Beneficiarios totales de Medicare y Medicaid atendidos: 14.6 millones

• Medicare Advantage afiliados: 8.3 millones
• Medicaid Managed Care Infusiles: 6.3 millones

Empresas de pequeñas y medianas empresas

Elevance Health cubre 1,2 millones de pequeñas a medianas empresas en los Estados Unidos.

Tamaño de negocio	Número de negocios	Empleados promedio por negocio
Pequeñas empresas (10-50 empleados)	780,000	25
Empresas medianas (51-500 empleados)	420,000	150

Profesionales de trabajo por cuenta propia

Elevance Health atiende a 2,1 millones de profesionales por cuenta propia en varios sectores.

• Freelancers: 1.2 millones
• Contratistas independientes: 580,000
• Propietarios de pequeñas empresas: 320,000

Elevance Health Inc. (ELV) - Modelo de negocio: Estructura de costos

Mantenimiento de la red de proveedores de atención médica

En 2023, Elevance Health Inc. reportó gastos de mantenimiento de la red de $ 4.2 mil millones. El desglose de costos incluye:

Categoría de gastos	Cantidad ($ millones)
Negociaciones de contratos de proveedor	1,350
Acreditación de red	620
Gestión del desempeño del proveedor	780

Gastos de procesamiento de reclamos

Los costos de procesamiento de reclamos para Elevance Health en 2023 totalizaron $ 2.8 mil millones.

• Infraestructura de procesamiento de reclamos digitales: $ 890 millones
• Revisión de reclamos manuales: $ 650 millones
• Sistemas de detección de fraude de reclamos: $ 420 millones

Tecnología e infraestructura digital

La inversión tecnológica para 2023 alcanzó los $ 1.6 mil millones.

Segmento tecnológico	Gasto ($ millones)
Computación en la nube	520
Ciberseguridad	340
Plataformas de salud digital	450

Costos administrativos y operativos

Los gastos administrativos para 2023 fueron de $ 3.5 mil millones.

• Sobrecosidad corporativa: $ 1.2 mil millones
• Recursos humanos: $ 620 millones
• Cumplimiento e informes regulatorios: $ 540 millones

Gastos de marketing y adquisición de clientes

Los gastos de marketing para 2023 totalizaron $ 1.1 mil millones.

Canal de marketing	Gasto ($ millones)
Marketing digital	420
Publicidad tradicional	350
Costos representativos de ventas	330

Elevance Health Inc. (ELV) - Modelo de negocios: flujos de ingresos

Primas de seguro de salud

Ingresos de prima de seguro de salud total para Elevance Health Inc. en 2022: $ 117.7 mil millones

Segmento	Ingresos premium (2022)
Seguro comercial	$ 48.3 mil millones
Seguro médico del estado	$ 35.6 mil millones
Seguro de enfermedad	$ 33.8 mil millones

Reembolsos del programa de salud gubernamental

Reembolsos de atención médica total del gobierno en 2022: $ 69.4 mil millones

• Reembolsos de Medicare Advantage: $ 42.1 mil millones
• Reembolsos de atención administrada de Medicaid: $ 27.3 mil millones

Tarifas del programa de bienestar

Ingresos del programa de bienestar en 2022: $ 1.2 mil millones

Cargos de servicio de salud digital

Ingresos del servicio de salud digital en 2022: $ 780 millones

Tipo de servicio digital	Ganancia
Servicios de telesalud	$ 420 millones
Monitoreo de pacientes remotos	$ 210 millones
Gestión de atención digital	$ 150 millones

Ingresos de gestión de beneficios de farmacia

Ingresos de gestión de beneficios de farmacia en 2022: $ 24.6 mil millones

• Procesamiento de reclamos de medicamentos recetados: $ 18.3 mil millones
• Gestión de la red de farmacia: $ 4.2 mil millones
• Precios de drogas y servicios de reembolso: $ 2.1 mil millones

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.