Humana Inc. (HUM): Lienzo del Modelo de Negocio [Actualizado en Ene-2025]

En el panorama dinámico del seguro de salud, Humana Inc. se erige como una fuerza transformadora, reinventando cómo los estadounidenses acceden y experimentan cobertura médica. Con un modelo de negocio estratégico que combina la tecnología innovadora sin problemas, la gestión de la atención integral y las soluciones centradas en el cliente, Humana se ha posicionado como un ecosistema de atención médica pionero que va más allá de los paradigmas de seguros tradicionales. Al aprovechar plataformas digitales avanzadas, extensas redes de proveedores y programas de bienestar personalizados, la compañía no solo vende un seguro, sino que elabora experiencias de atención médica holística que potencian a los miembros de Medicare, Medicaid y los planes de salud individuales para tomar el control de su bienestar.

Humana Inc. (HUM) - Modelo de negocios: asociaciones clave

Proveedores de atención médica y redes hospitalarias

Humana tiene asociaciones con 67,600 médicos de atención primaria y 430,000 especialistas en los Estados Unidos a partir de 2023. La compañía mantiene colaboraciones estratégicas con aproximadamente 3,800 hospitales en todo el país.

Tipo de socio	Número de socios	Área de cobertura
Médicos de atención primaria	67,600	A escala nacional
Médicos especializados	430,000	A escala nacional
Hospitales	3,800	A escala nacional

Redes del plan de Medicare Advantage

Humana opera en 49 estados con planes de Medicare Advantage, atendiendo a 5.3 millones de miembros de Medicare Advantage a partir del cuarto trimestre de 2023.

Gerentes de beneficios de farmacia

HumanA colabora con múltiples socios de gestión de beneficios de farmacia (PBM) para optimizar los servicios de medicamentos recetados.

• Partner PBM principal: Soluciones de farmacia Humana
• Cobertura de red: más de 68,000 farmacias minoristas
• Volumen de prescripción: aproximadamente 300 millones de recetas procesadas anualmente

Tecnología y socios de soluciones de salud digital

Humana invierte $ 1.2 mil millones anuales en tecnología y innovaciones de salud digital. Las asociaciones de tecnología clave incluyen:

Socio tecnológico	Área de enfoque	Año de asociación
Google Cloud	Análisis de datos de atención médica	2021
Salud de teladoc	Servicios de telesalud	2019
Manzana	Monitoreo de la salud digital	2020

Empresas de seguros y reaseguros

Humana mantiene acuerdos de reaseguro que cubren aproximadamente $ 8.5 mil millones en una posible transferencia de riesgo a partir de 2023.

Socio de reaseguros	Monto de cobertura de riesgo	Tipo de cobertura
Swiss RE	$ 3.2 mil millones	Reclamos médicos
Munich re	$ 2.7 mil millones	Vida y discapacidad
Hannover re	$ 2.6 mil millones	Salud integral

Humana Inc. (HUM) - Modelo de negocio: actividades clave

Seguro de la salud y gestión de cobertura

A partir de 2024, Humana maneja aproximadamente 4.9 millones de miembros de Medicare Advantage. La empresa procesa un 185 millones de reclamos de atención médica anualmente.

Segmento de seguro	Miembro Count	Reclamaciones anuales procesadas
Ventaja de Medicare	4.9 millones	185 millones

Administración del servicio de Medicare y Medicaid

Humana opera en 44 estados para servicios de Medicare, con un $ 22.4 mil millones de ingresos de segmentos gubernamentales en 2023.

• Cuota de mercado de Medicare Advantage: 8%
• Miembros de la atención administrada de Medicaid: 1.2 millones

Gestión de beneficios de farmacia

Los servicios de farmacia de Humana se administran $ 54.3 mil millones en costos de medicamentos recetados anualmente.

Métricas de farmacia	Valor anual
Costos de medicamentos recetados gestionados	$ 54.3 mil millones
Tamaño de la red de farmacia	67,000 farmacias

Desarrollo de tecnología de salud digital

Humana invertido $ 486 millones en tecnología e innovación en 2023, centrándose en la telesalud y las plataformas de monitoreo remoto.

• Plataformas de salud digital: 3 plataformas principales
• Interacciones de telesalud: 2.7 millones de consultas anuales

Programas de coordinación y bienestar de la atención

Humana maneja Más de 500 programas de bienestar y cuidados preventivos, sirviendo aproximadamente 5.3 millones de participantes.

Métricas del programa de bienestar	Conte/participantes
Programas de bienestar total	500+
Participantes del programa	5.3 millones

Humana Inc. (HUM) - Modelo de negocios: recursos clave

Extensa red de proveedores de atención médica

A partir de 2024, Humana mantiene una red de aproximadamente 455,000 proveedores de atención médica en los Estados Unidos. La red incluye:

Tipo de proveedor	Número de proveedores
Médicos de atención primaria	87,300
Especialistas	193,500
Hospitales	4,800
Farmacias	169,400

Capacidades de análisis de datos avanzados

La infraestructura de análisis de datos de Humana incluye:

• Más de 20 petabytes de datos de atención médica procesados ​​anualmente
• Algoritmos de aprendizaje automático Análisis de patrones de salud del paciente
• Plataformas de modelado predictivo que cubren 14 millones de registros individuales de pacientes

Plataformas de salud digital e infraestructura tecnológica

Detalles de la inversión tecnológica:

Categoría de tecnología	Monto de inversión (2024)
Plataformas de salud digital	$ 342 millones
Infraestructura de ciberseguridad	$ 127 millones
Telologías de telesalud	$ 89 millones

Capital financiero fuerte y reservas

Recursos financieros a partir del cuarto trimestre 2023:

• Activos totales: $ 75.3 mil millones
• Equivalentes en efectivo y efectivo: $ 4.2 mil millones
• Equidad total de los accionistas: $ 18.6 mil millones

Equipos experimentados de gestión de la salud

Métrica de gestión	Estadística
Experiencia de atención médica ejecutiva promedio	22.4 años
Liderazgo superior con títulos avanzados	87%
Promociones internas a roles de liderazgo	63%

Humana Inc. (Hum) - Modelo de negocio: propuestas de valor

Opciones integrales de cobertura de atención médica

Humana ofrece cobertura de atención médica con ingresos totales de $ 92.1 mil millones en 2022. Los planes de Medicare Advantage cubrieron 5.3 millones de miembros a partir del cuarto trimestre de 2022.

Tipo de cobertura	Miembro Count	Prima anual
Ventaja de Medicare	5.3 millones	$ 6,780 por miembro
Seguro comercial	1.2 millones	$ 5,400 por miembro
Seguro de enfermedad	1.8 millones	$ 4,200 por miembro

Soluciones personalizadas de Medicare y Medicaid

HumanA ofrece soluciones especializadas de Medicare con un 87% de calificación de satisfacción del cliente.

• Planes de suplementos de Medicare
• Cobertura de receta Parte D de Medicare
• Planes de necesidades especiales de Medicare Advantage

Servicios de gestión de atención integrada

La gestión de atención integrada genera $ 3.2 mil millones en ingresos anuales con una efectividad de coordinación de atención del 92%.

Capacidades de salud digital y telemedicina

La plataforma de salud digital admite 2,4 millones de consultas virtuales en 2022, lo que representa un crecimiento año tras año.

Métrica de telemedicina	Datos 2022
Consultas virtuales	2.4 millones
Usuarios de la plataforma de salud digital	1.6 millones

Bienestar preventivo y programas de manejo de enfermedades crónicas

Los programas de gestión de enfermedades crónicas atienden a 3,1 millones de miembros con $ 1.5 mil millones invertidos anualmente.

• Programa de manejo de la diabetes
• Prevención de la enfermedad cardíaca
• Servicios de control de peso

Humana Inc. (HUM) - Modelo de negocios: relaciones con los clientes

Portales de miembros en línea y aplicaciones móviles

A partir de 2024, las plataformas digitales de Humana atienden a aproximadamente 5.3 millones de usuarios digitales activos. La aplicación móvil MyHumana se ha descargado más de 2.1 millones de veces, con una calificación de usuario de 4.6/5.

Métrica de plataforma digital	2024 estadísticas
Usuarios digitales activos	5.3 millones
Descargas de aplicaciones móviles	2.1 millones
Calificación del usuario de la aplicación móvil	4.6/5

Centros de atención al cliente 24/7

Humana opera 17 centros de atención al cliente A nivel nacional, que maneja aproximadamente 3.8 millones de interacciones de los clientes mensualmente.

• Tiempo de resolución de llamadas promedio: 8.2 minutos
• Tasa de satisfacción del cliente: 89%
• Soporte multilingüe disponible en 6 idiomas

Servicios de coaching de salud personalizados

En 2024, Humana ofrece entrenamiento de salud personalizado a 672,000 miembros, con una duración promedio de participación de 6.4 meses por participante.

Métrica de coaching de salud	2024 datos
Miembros que reciben coaching	672,000
Duración promedio de coaching	6.4 meses

Evaluaciones regulares de riesgos para la salud

Humana realiza evaluaciones de riesgos para la salud para 1.9 millones de miembros anualmente, con una tasa de finalización del 73%.

• Tasa de finalización de la evaluación: 73%
• Tiempo de evaluación promedio: 22 minutos
• Opciones de evaluación digital: 64% de las evaluaciones

Programas de educación sobre salud comunitaria

Humana apoya 287 iniciativas de educación en salud comunitaria en 42 estados, llegando a aproximadamente 1,1 millones de participantes en 2024.

Métrico del programa comunitario	2024 estadísticas
Iniciativas de la comunidad	287
Estados cubiertos	42
Participantes del programa	1.1 millones

Humana Inc. (Hum) - Modelo de negocios: canales

Plataformas digitales y aplicaciones móviles

Los canales digitales de Humana incluyen:

• Aplicación móvil MyHumana con 2.3 millones de usuarios activos a partir del cuarto trimestre 2023
• Portal de pacientes en línea con 4.7 millones de usuarios registrados
• Servicios de TeleSealth que respaldan 1,2 millones de consultas virtuales anualmente

Plataforma digital	Métricas de usuario	Compromiso anual
Aplicación móvil myhumana	2.3 millones de usuarios activos	8,6 millones de interacciones totales
Portal de pacientes en línea	4.7 millones de usuarios registrados	15.3 millones de inicios de sesión anuales

Representantes de ventas directas

Humana mantiene una fuerza de ventas directas de 3.742 representantes de seguros dedicados a partir de 2024.

• Productividad de representante promedio de ventas: ingresos anuales de $ 1.2 millones
• Cobertura geográfica en 50 estados
• Equipos especializados para mercados de Medicare, comerciales e individuales

Corredores de seguro y agentes

La red de corredores de Humana incluye:

• 17.500 agentes de seguros independientes contratados
• Estructura de la comisión que va del 3 al 8% por política
• Ingresos anuales generados por los corredores: $ 2.4 mil millones

Asociaciones del grupo de empleadores

Categoría de asociación	Número de asociaciones	Vidas cubiertas
Grandes empleadores (más de 1000 empleados)	423 asociaciones	1.6 millones de vidas cubiertas
Empleadores de tamaño mediano (100-999 empleados)	1.872 asociaciones	2,3 millones de vidas cubiertas

Sitios web de marketing y comparación en línea

Inversiones de canales de marketing digital:

• Presupuesto anual de marketing digital: $ 87.6 millones
• Asociaciones con 12 plataformas de comparación de seguros principales
• Gasto de publicidad digital dirigida: $ 42.3 millones

Canal en línea	Alcance anual	Tasa de conversión
Google AdWords	3.2 millones de impresiones	4.7%
Sitios de comparación de seguros	2.8 millones de visitantes únicos	3.9%

Humana Inc. (HUM) - Modelo de negocios: segmentos de clientes

Individuos elegibles de Medicare

A partir de 2023, Humana atiende a aproximadamente 5.3 millones de miembros de Medicare Advantage. El segmento de Medicare de la compañía representa un segmento crítico de clientes con el siguiente desglose:

Métrica del segmento de Medicare	Datos cuantitativos
Miembros totales de Medicare Advantage	5.3 millones
Inscuros de seguros de suplementos de Medicare	1.2 millones
Medicare Parte D Membres del plan de medicamentos recetados	3.8 millones

Receptores de Medicaid

El segmento de Medicaid de Humana se centra en los servicios de atención médica estatales:

• Total de los miembros de Medicaid: 1.1 millones
• Operativo en 18 estados
• Vidas de Medicaid administradas: 756,000

Consumidores de atención médica senior

Humana se dirige específicamente a las personas mayores con soluciones de atención médica especializadas:

Métricas de atención médica para personas mayores	Datos cuantitativos
65+ grupo de edad cubierto	4.9 millones de personas
Planes de atención médica específicos para personas mayores	42 configuraciones de planes diferentes

Miembros del plan de salud del grupo de empleadores

El segmento comercial de Humana incluye soluciones integrales de salud del empleador:

• Total de los miembros del grupo de empleadores: 2.6 millones
• Cuota de mercado de grupos pequeños: 7.2%
• Cobertura del mercado de grupos grandes: 1.4 millones de miembros

Buscadores de seguro de salud individual

Detalles del segmento de mercado individual:

Métricas de mercado individuales	Datos cuantitativos
Total de miembros del mercado individual	853,000
Participantes del mercado de ACA	412,000
Inscuros de seguro de salud no grupal	441,000

Humana Inc. (Hum) - Modelo de negocio: Estructura de costos

Reembolsos del servicio de atención médica

En 2023, los costos de reembolso de servicios de salud totales de HumanA fueron de aproximadamente $ 61.4 mil millones. El desglose de los gastos de reembolso incluye:

Categoría de reembolso	Costo ($)
Reclamaciones de Medicare Advantage	42.3 mil millones
Reclamaciones de seguro comercial	12.7 mil millones
Reembolsos de Medicaid	6.4 mil millones

Inversiones de tecnología e infraestructura

Las inversiones de tecnología e infraestructura de Humana para 2023 totalizaron $ 1.2 mil millones, con asignaciones específicas:

• Plataformas de salud digital: $ 425 millones
• Infraestructura de computación en la nube: $ 310 millones
• Sistemas de ciberseguridad: $ 215 millones
• Sistemas de análisis de datos: $ 250 millones

Compensación y beneficios de los empleados

Los gastos totales relacionados con los empleados en 2023 fueron de $ 8.6 mil millones, estructurados de la siguiente manera:

Categoría de compensación	Costo ($)
Salarios base	5.400 millones
Beneficios de atención médica	1.700 millones
Contribuciones de jubilación	680 millones
Bonos de rendimiento	820 millones

Gastos de marketing y adquisición de clientes

Los gastos de marketing para 2023 ascendieron a $ 1.5 mil millones, distribuidos en todos los canales:

• Marketing digital: $ 520 millones
• Publicidad tradicional: $ 410 millones
• Comisiones de ventas directas: $ 370 millones
• Programas de retención de clientes: $ 200 millones

Cumplimiento regulatorio y costos administrativos

El cumplimiento y los gastos administrativos en 2023 fueron de $ 2.3 mil millones, con la siguiente asignación:

Categoría de cumplimiento	Costo ($)
Cumplimiento legal y regulatorio	850 millones
Sobrecarga administrativa	740 millones
Auditoría y gestión de riesgos	410 millones
Informes y documentación	300 millones

HumanA Inc. (HUM) - Modelo de negocios: flujos de ingresos

Medicare Advantage Plan primas

Para el año fiscal 2023, el segmento de Medicare Advantage de Humana generó $ 23.4 mil millones en ingresos premium. La compañía reportó 5.3 millones de miembros de Medicare Advantage al 31 de diciembre de 2023.

Año	Medicare Advantage Premiums	Totales miembros
2023	$ 23.4 mil millones	5.3 millones

Contratos de servicio de Medicaid

El segmento de Medicaid de Humana generó $ 5.2 mil millones en ingresos para 2023, atendiendo a aproximadamente 1.1 millones de miembros de Medicaid en múltiples estados.

Tarifas de gestión de beneficios de farmacia

Los ingresos por servicios de farmacia para 2023 alcanzaron $ 16.8 mil millones, con Tarifas de gestión de beneficios de farmacia (PBM) contribuyendo significativamente a este total.

Categoría de servicio PBM	Ingresos (2023)
Procesamiento de recetas	$ 4.6 mil millones
Gestión de redes	$ 3.2 mil millones

Ingresos del servicio de tecnología de salud

Los servicios de tecnología de salud de Humana generaron ingresos de $ 780 millones para 2023, centrándose en plataformas de salud digitales y tecnologías de coordinación de atención.

• Servicios de telesalud: $ 245 millones
• Software de gestión de atención: $ 335 millones
• Plataformas de salud digital: $ 200 millones

Venta de productos de seguro suplementario

Los ingresos por productos de seguro suplementarios totalizaron $ 2.1 mil millones en 2023, incluidas las ofertas de suplementos de Medicare y seguros dentales.

Producto suplementario	Ingresos (2023)
Suplemento de Medicare	$ 1.4 mil millones
Seguro dental	$ 420 millones
Seguro de visión	$ 280 millones

Humana Inc. (HUM) - Canvas Business Model: Value Propositions

You're looking at the core value Humana Inc. (HUM) delivers to its members and the market as of late 2025. It's all about making senior healthcare more accessible, integrated, and predictable, especially through its CenterWell division. The numbers show a clear focus on scaling its provider arm while managing the core insurance risk.

Comprehensive, affordable Medicare Advantage plans for seniors

Humana Inc. is definitely leaning into the Medicare Advantage (MA) space, which is where a lot of the action is for seniors. For the 2025 plan year, you can see the sheer scale of their offering; they have a total of 793 individual Medicare Advantage plans available across the country. As of the third quarter of 2025, the total medical membership across all segments stood at 15 million lives. The company is strategically managing its MA footprint, revising its expected individual MA membership decline for the full year 2025 to be up to 425,000 members, which is an improvement from earlier estimates, suggesting better retention or sales execution. To make these plans accessible, Humana is expanding its geographic reach, offering MA plans in 48 states, plus Washington, D.C., and Puerto Rico, covering 89% of U.S. counties. Affordability is highlighted by specific plan features; for instance, one group Medicare Advantage PPO plan has a stated monthly premium of $533.09.

Integrated primary care, pharmacy, and home health services via CenterWell

The integration of services through CenterWell is a major differentiator. This isn't just an insurer; it's an integrated care delivery system. CenterWell Primary Care is seeing aggressive growth targets, anticipating a net patient growth for FY 2025 between 50,000 to 70,000 new patients. This growth is supported by a physical footprint that, when combined with its sister brand Conviva Senior Primary Care, operates more than 340 centers. The financial contribution is growing too; CenterWell's operating income in the second quarter of 2025 reached $344 million, marking a 2% year-over-year increase. On the pharmacy side, CenterWell Pharmacy is recognized for its service, winning the MMIT Patient Choice award for the 7th time in 8 years of the program's history. This integration is key to their overall financial health, as evidenced by the affirmed FY 2025 Adjusted EPS guidance of approximately $17.00.

Coordinated, value-based care focused on holistic well-being

The value proposition centers on moving from fee-for-service to value-based care, aiming for better patient outcomes. This focus is reflected in the insurance segment's performance metrics, where the benefit ratio for Q3 2025 was 91.1%, showing management's focus on medical cost control relative to premiums collected. Holistic well-being is delivered through concrete programs. For example, members discharged from the hospital via the CenterWell program can be eligible for 28 free nutritious frozen pre-cooked meals delivered to their door. This approach is designed to support the company's overall revenue goal, with FY 2025 consolidated revenues guided to be at least $128 billion.

Predictable out-of-pocket costs and supplemental benefits

Predictability in costs is crucial for seniors planning their fixed incomes. You see this in the structure of their plans, which cap out-of-pocket exposure. For one specific Medicare Advantage Prescription Drug Plan, the annual maximum out-of-pocket cost is set at $2,000. Furthermore, for a specific PPO plan, the in-network maximum out-of-pocket limit for Medicare-covered services is $1,200. Supplemental benefits are also a key feature, with Humana including coverage for new glasses every year in every plan that offers a vision benefit for 2025. The table below summarizes some of these key cost and benefit structures found across their 2025 offerings.

Here's a quick look at some of the cost and benefit structures:

Value Proposition Element	Metric/Amount	Context/Plan Type
Annual Maximum Out-of-Pocket (Part D)	$2,000	Humana Value Rx Plan (2025)
In-Network Max Out-of-Pocket (Medical Services)	$1,200	KPPA Group Medicare Advantage PPO (2025)
Monthly Premium Example	$533.09	KPPA Group Medicare Advantage PPO (2025)
Dental Benefit Example	50% of cost for amalgam or composite filling up to 1 per year	KPPA Group Medicare Advantage PPO (2025)
Post-Discharge Meal Benefit	28 free nutritious frozen pre-cooked meals	CenterWell Program (2025)

Access to a growing CenterWell Primary Care network

The expansion of the physical care network directly supports the value proposition of integrated, coordinated care. You saw the patient growth target earlier, but the physical expansion is also significant. Humana plans to add between 20 to 30 new centers in existing markets in 2025, including 11 Walmart co-located sites expected to open by year-end. This growth is happening across new metro areas like Augusta, GA, and Wichita, KS. The focus is on scaling the delivery assets-primary care, home health, and pharmacy-to deliver that superior patient experience. The company's confidence in its strategy, which includes this provider growth, is underpinned by its Q3 2025 adjusted earnings per share of $3.24.

You should definitely track the net patient growth against that 50,000 to 70,000 target, as that's the clearest measure of the CenterWell value proposition scaling in real-time. Finance: draft 13-week cash view by Friday.

Humana Inc. (HUM) - Canvas Business Model: Customer Relationships

You're looking at how Humana Inc. connects with the millions of members and patients relying on their services as of late 2025. It's a mix of high-touch clinical interaction and scalable digital support, especially within their CenterWell ecosystem.

Dedicated care coordination and navigation services

Humana Inc. focuses on value-based care models, which inherently require deep coordination. This is evident in the growth of their integrated care delivery assets. The company continues to strategically expand its footprint in CenterWell and Medicaid, aiming for sustainable, long-term value creation through improved outcomes.

The scale of their integrated care delivery organization is significant:

• CenterWell Primary Care anticipated FY 2025 net patient growth between 50,000 to 70,000 new patients.
• CenterWell Primary Care reported growth of 56,600 patients in 3Q25 compared to December 31, 2024, representing nearly 15 percent growth at the midpoint.
• Humana's Medicare Advantage segment, as of June 30, 2024, served more than 5.6 million members.
• The company affirmed its expectation for an individual Medicare Advantage membership decline of approximately 425,000 members for FY 2025, driven by stronger retention and better sales than previously anticipated.

High-touch, personalized engagement through CenterWell clinics

The CenterWell brand is the physical manifestation of this high-touch approach, particularly for seniors. They are actively expanding this physical presence to meet demand in value-based care settings. This model emphasizes spending more time with patients, focusing on both physical and mental health aspects.

Here's a look at the physical footprint and patient base for the senior-focused primary care division as of late 2025:

Metric	Value/Target (2025)	Context/Date
Total Seniors Served (CenterWell & Conviva)	390,000	As of December 31, 2024
New Center Target (Total)	50 new centers	Plan for 2025
New Centers in Existing Markets (Planned)	20 to 30 new centers	Planned for 2025 across 11 states
New Walmart Co-located Sites (Planned)	11 locations	Set to open by the end of 2025
Total Centers Operated (Approximate)	Over 340 centers	As of September 30, 2023

To be fair, the focus on value-based care means the relationship is measured by outcomes; value-based care patients showed a 14.6 percent higher rate of completing preventive screenings compared to non-value-based Medicare Advantage members in 2022. Also, Humana received the highest CX Index score among health insurers in Forrester's proprietary 2024 Customer Experience Benchmark Survey.

Broker/agent-assisted sales and enrollment

For Medicare Advantage and other individual products, the broker and agent channel remains a key touchpoint for new enrollment. Humana Inc. structures its relationship with these external partners through detailed commission and partnership plans.

The relationship is governed by specific compensation structures:

• Some commission structures for Dental agents in 2025 indicated a New/Renewal rate of 7% / 7%.
• The 2026 Individual Products Producer Partnership Plan (PPP) outlines commission rates based on beneficiary location and prior history.
• Agents must complete annual AHIP Medicare certification and Humana's product-specific training to sell Medicare plans.

Digital self-service tools and telehealth options

Humana Inc. is pushing digital integration to streamline administrative interactions, freeing up clinical staff for more complex needs. This is a clear move toward automated, efficient service delivery.

You see this in their technology partnerships:

The digital insurance verification workflow, activated with Epic, now supports over 800,000 Humana Medicare Advantage members across 120 health systems as of November 2025. This automation cut registration time by about 90 seconds per patient interaction in early studies. That's 90 seconds saved on every check-in, which adds up fast. Furthermore, CenterWell Pharmacy won the MMIT Patient Choice award for the 7th time in 8 years of the program's history.

Finance: draft 13-week cash view by Friday.

Humana Inc. (HUM) - Canvas Business Model: Channels

You're looking at how Humana Inc. gets its value propositions to its distinct customer segments, and it's a multi-pronged approach blending physical locations, digital interfaces, and third-party intermediaries.

CenterWell Primary Care centers and Home Health services

The physical delivery channel for Humana Inc.'s healthcare services is heavily weighted through its CenterWell segment.

• CenterWell Senior Primary Care and Conviva operated over 340 centers as of December 31, 2024.
• These centers delivered care to approximately 390,000 seniors at the end of 2024.
• CenterWell added 56,600 patients since December 2024, representing a 15% growth rate as of the third quarter of 2025.
• CenterWell revenues reached $5.9 billion in the third quarter of 2025.
• The organization planned to add 20-30 new centers in 2025, including 23 co-located at select Walmart locations expected to open by the middle of 2025.

Independent and captive insurance agents/brokers

Humana Inc. relies on a network of agents and brokers, particularly for its Medicare Advantage offerings, though compensation structures are dynamic.

Here are examples of the distribution of Humana MarketPoint® licensed Medicare agents across select states:

State	Number of MarketPoint Agents (Example Data)
Florida	189
Texas	88
Illinois	41
Georgia	39
Ohio	36
Virginia	30

Reports indicate that Humana and UnitedHealth were reportedly reducing broker commissions for certain Medicare Advantage plans as of late 2025.

Direct-to-consumer marketing (TV, direct mail, digital)

Significant investment drives awareness and direct enrollment across various media.

• Humana Inc. spent over $100 million on advertising across digital, print, and national TV in the last year leading up to late 2025.
• The company advertised on over 250 different Media Properties in the last year across multiple formats.
• Humana launched and advertised 8 new products in the past twelve months.
• CenterWell Pharmacy growth was spurred by investments in partnerships for direct-to-consumer sales, such as the deal with Novo Nordisk for GLP-1 medications.

Online enrollment platforms and Humana.com

Digital channels facilitate both consumer self-service and agent support.

• Humana.com hosts secure sections for agents and brokers to manage compensation reports and update direct deposit information.
• The company maintains a social media presence, including over 400K followers on Facebook and over 13K followers on Instagram as of late 2025 data points.
• Virtual care and an online health portal are available to keep patients connected.

State-based Medicaid contracts (e.g., new Virginia contract)

State contracts provide a scalable revenue stream by managing care for large, defined populations.

• Humana launched its Humana Healthy Horizons Medicaid plan in Virginia under the Cardinal Care program in July 2025.
• Through the Humana Healthy Horizons brand, the company served nearly 1.5 million Medicaid members nationally as of July 2025.
• Humana committed an additional $2 million over the next five years to the Virginia Health Care Foundation (VHCF), following an initial $500,000 investment to support behavioral health workforce expansion in Virginia.

Humana Inc. (HUM) - Canvas Business Model: Customer Segments

You're looking at the core groups Humana Inc. serves as of late 2025, which is heavily concentrated in government-sponsored programs. Honestly, the story here is managing the massive Medicare Advantage base while growing in other areas.

Seniors aged 65+ (Individual Medicare Advantage is the core)

This group remains the bedrock of Humana Inc.'s business. For the fiscal year 2025, the company revised its expectation for the decline in individual Medicare Advantage membership to be around 425,000 members, which is an improvement from the earlier projection of a decrease up to 500,000 members. This suggests stronger retention and better sales performance than initially modeled for the year. As of the third quarter of 2025, the company was grappling with pressures in this segment, posting a medical cost ratio of 91.1%. To serve this segment, Humana Inc. offered a total of 793 individual Medicare Advantage plans throughout the country for 2025. The overall geographic reach for these plans covers 89% of U.S. counties across 48 states, plus Washington, D.C., and Puerto Rico.

Dual Eligible Special Needs Plan (D-SNP) members

D-SNP members, those eligible for both Medicare and Medicaid, are a critical, high-touch sub-segment. As of December 31, 2024, Humana Inc. reported approximately 814,000 D-SNP members within its Individual Medicare Advantage count. This represented a decrease of 123,100 members from the end of 2023. Still, the company is actively expanding this offering; for instance, D-SNPs were set to be offered in North Dakota in 2025, and Humana Inc. launched a Virginia Medicaid contract in July 2025, opening a new D-SNP market growth opportunity there.

Medicaid beneficiaries (via Humana Healthy Horizons)

While specific standalone Medicaid enrollment numbers for the Humana Healthy Horizons brand aren't explicitly broken out against the total membership, the Medicaid business is a key part of the Insurance segment, which reported total medical membership of 15 million as of September 30, 2025. The company continues to strategically expand within its Medicaid business.

Military families and retirees (TRICARE)

Humana Inc.'s nearly all of its medical membership stems from Medicare, Medicaid, and the military's TRICARE program. Specific 2025 membership figures for the TRICARE customer segment are not separately itemized in the latest reports, but it forms a recognized pillar alongside government programs.

Employer groups (Group and Specialty segment)

This segment includes Group Medicare Advantage and specialty health insurance products. Group Medicare Advantage membership was expected to remain relatively flat compared to the end of 2024. Furthermore, the company has been strategically exiting the employer group commercial medical products business, which impacted first-quarter 2025 results.

Here's a quick look at the scale of the core government-backed membership as of the latest reporting periods:

Customer Segment Focus	Metric	Latest Reported Number
Individual Medicare Advantage (Core)	Expected FY 2025 Net Membership Decline	425,000 members
Individual Medicare Advantage (Core)	Total Individual MA Plans Offered (2025)	793 plans
D-SNP Members	Approximate Membership (as of 12/31/2024)	814,000 members
Total Insurance Segment Medical Membership	Total Medical Membership (as of 9/30/2025)	15 million
Group Medicare Advantage	FY 2025 Membership Outlook	Relatively flat vs. 2024-end

The value proposition tailored to these segments is reflected in the product structure, which includes specific benefits for D-SNP members, such as:

• $0 copays for hundreds of covered prescriptions in many D-SNPs.
• Coverage for routine dental, vision, and hearing care not provided by Original Medicare.
• Monthly allowance for over-the-counter (OTC) items.

The company's overall strategy involves prioritizing membership expected to drive sustainable, long-term value creation. Finance: draft 13-week cash view by Friday.

Humana Inc. (HUM) - Canvas Business Model: Cost Structure

The cost structure for Humana Inc. is heavily weighted toward medical costs, which is typical for a managed care organization. You're looking at the core expenses that drive the bottom line, so these ratios are key to understanding profitability.

The largest component of Humana Inc.'s cost structure is the Medical Benefit Expenses, which represents the claims paid out for member care. For the full fiscal year 2025, Humana Inc. affirms its guidance for the Insurance unit benefit ratio to be in the range of 90.1% to 90.5%. To be fair, the actual third quarter 2025 insurance segment benefit ratio came in slightly higher at 91.1%.

The second major cost category involves the Operating and administrative costs, often referred to as the operating cost ratio. The consolidated adjusted operating cost ratio is anticipated to fall between 11.3% and 11.7% for 2025. The third quarter 2025 adjusted operating cost ratio was reported at 11.8%. This ratio reflects costs like salaries, IT, and general overhead.

Here's a quick look at the key projected cost ratios for 2025:

Cost Component	Projected FY 2025 Ratio Range	Latest Reported Quarter (Q3 2025) Ratio
Medical Benefit Expenses (Benefit Ratio)	90.1% to 90.5%	91.1%
Operating and Administrative Costs (Adjusted Operating Cost Ratio)	11.3% to 11.7%	11.8%

Humana Inc.'s focus on value-based care directly impacts provider compensation costs by shifting incentives. The company is actively expanding these models. For instance, through CenterWell Home Health and OneHome, Humana stated an expectation of growing members in some form of value-based home health model by greater than 15% during 2025.

The company's spending on Technology and data infrastructure investments is embedded within the operating costs, but specific standalone figures for this investment are not detailed as a primary cost structure line item in the latest guidance summaries. However, the overall capital deployment plan is clear.

Capital expenditures for Humana Inc. are projected to be roughly $650 million for the fiscal year 2025.

Other financial data points related to operational spending include:

• GAAP cash flow from operations continues to be estimated within $2.4 billion and $2.9 billion for 2025.
• Net income for the third quarter 2025 totaled $195 million.
• Adjusted earnings per share (EPS) estimate for FY 2025 is reiterated at around $17.00.

Finance: draft 13-week cash view by Friday.

Humana Inc. (HUM) - Canvas Business Model: Revenue Streams

You're looking at the core ways Humana Inc. brings in cash as of late 2025. The business model leans heavily on government-sponsored health plans, but the growth story is increasingly tied to its health services arm, CenterWell. The company has shown confidence in its 2025 financial trajectory, raising its top-line expectations.

The overall expected top-line number for the full fiscal year 2025 is a significant benchmark:

• Full-year consolidated revenues guided to be at least $128 billion.

To give you a sense of the quarterly run rate supporting that guidance, Humana reported total revenue of $32.4 billion for the second quarter ended June 30, 2025.

The revenue streams are fundamentally split between the Insurance segment (premiums) and the CenterWell segment (services). Based on the latest available full-year segment data structure (FY 2024), the Insurance Segment accounted for approximately 85.09% of total revenue, while the CenterWell Segment accounted for approximately 14.91%. This structure underpins the 2025 guidance.

Here is a breakdown of the key components feeding into that revenue:

Revenue Stream Component	Latest Specific Data Point (2025)
Government premiums from Medicare Advantage and Medicaid	Anticipated individual Medicare Advantage membership decline revised to be up to 500,000 members for FY 2025.
Premiums from commercial and specialty insurance products	The company is strategically exiting the employer group commercial medical products business.
Service revenue from CenterWell (pharmacy, primary care, home health)	CenterWell reported $5.5 billion in revenue for the second quarter of 2025, an 11.9% increase year-over-year.
Full-year consolidated revenues guided to at least $128 billion	Raised from a previous range of $126 billion to $128 billion as of Q2 2025 guidance update.
Investment income from cash and short-term investments	Revenue projections include expected investment income.

Focusing on the CenterWell growth engine, which diversifies the revenue base away from pure insurance premiums, you see concrete operational metrics driving that service revenue:

• CenterWell Primary Care anticipated FY 2025 net patient growth between 50,000 to 70,000 patients.
• CenterWell Pharmacy growth was strong, with increased Specialty volumes and Direct to Consumer growth exceeding previous expectations in Q3 2025.

For the government-backed premiums, the strategy involved significant recalibration to manage costs, which directly impacts premium revenue assumptions. Humana overhauled its Medicare Advantage plans for 2025 by cutting benefits and charging higher premiums. This was done while managing the expected individual MA membership decline, which improved to up to 500,000 members from the prior estimate of approximately 550,000.

Regarding investment income, while a specific dollar amount for the full year 2025 revenue contribution isn't explicitly itemized in the guidance breakdown, the company noted that comprehensive income in Q2 2025 was attributed to the increase in unrealized investment gains despite net losses on investment securities. The balance sheet reflects a strong position to generate this income, with Parent company cash and short-term investments reported at $1,334 million at the end of Q2 2025.