Alignment Healthcare, Inc. (ALHC): Business Model Canvas [Jan-2025 Mis à jour]

Dans le paysage rapide de l'innovation des soins de santé, Alignment Healthcare, Inc. (ALHC) émerge comme une force transformatrice, réinventer les solutions Medicare Advantage grâce à une approche sophistiquée et axée sur la technologie. En fabriquant méticuleusement un modèle d'entreprise qui intègre de manière transparente les soins personnalisés pour les patients, l'analyse avancée des données et la gestion complète des soins de santé, l'ALHC est à l'avant-garde de la livraison rentable et axéré sur le patient Expériences de soins de santé pour les personnes âgées. Ce plan stratégique répond non seulement aux besoins complexes des populations éligibles à Medicare, mais représente également un changement de paradigme dans la façon dont les services de santé sont conceptualisés, livrés et optimisés dans l'écosystème médical moderne.

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: partenariats clés

Plans de santé Medicare Advantage

Alignement Healthcare s'associe à plusieurs plans Medicare Advantage, notamment:

Plan de partenaire	Type de contrat	Couverture du marché
UnitedHealthcare Medicare Advantage	Contrat basé sur le risque	Californie, Floride, Nevada
Avantage Humana Medicare	Accord basé sur la valeur	Sélectionnez les marchés dans l'ouest des États-Unis

Fournisseurs de soins de santé et groupes médicaux

Les partenariats des fournisseurs clés comprennent:

• Groupe médical Memorial Care
• Réseau médical Cedars-Sinai
• Plans de santé Providence

Fournisseurs de technologie et de logiciels

Fournisseur	Solution technologique	Valeur du contrat annuel
Systèmes épiques	Dossiers de santé électroniques	3,2 millions de dollars
Salesforce	Gestion de la relation client	1,7 million de dollars

Sociétés d'analyse des données et de gestion des risques

Alignment Healthcare collabore avec des partenaires d'analyse de données spécialisés:

• IBM Watson Health
• Optum Analytics
• Catalyseur de santé

Brokers d'assurance et consultants

Partenaire	Spécialité	Portée géographique
Aon Hewitt	Conseil des avantages sociaux	National
Willis Towers Watson	Gestion des risques de santé	Multi-États

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: Activités clés

Gestion du plan Medicare Advantage

Au quatrième trimestre 2023, Alignment Healthcare a géré 60 342 membres de Medicare Advantage dans 10 États.

Couverture de l'État	Nombre de membres	Pénétration du marché
Californie	42,185	69.9%
Floride	8,756	14.5%
Autres États	9,401	15.6%

Coordination des soins et soutien des patients

En 2023, Alignment Healthcare a déployé 237 spécialistes de la coordination des soins.

• Ratio moyen patient / spécialiste: 1: 256
• Heures de soutien téléphonique: 8 h à 20 h HNE
• Interactions annuelles de coordination des soins: 412 675

Développement de la plate-forme technologique

Investissement en R&D en 2023: 24,3 millions de dollars

Domaine de mise au point technologique	Investissement	Étape de développement
Gestion des soins dirigés par l'IA	8,7 millions de dollars	Prototype avancé
Plateforme d'analyse prédictive	6,2 millions de dollars	Production
Engagement numérique des patients	9,4 millions de dollars	Éclatement

Stratification des risques et gestion de la santé de la population

L'analyse de gestion des risques a couvert 60 342 patients de patients en 2023.

• Taux d'identification des patients à haut risque: 22,4%
• Précision prédictive de la modélisation des risques: 87,6%
• Interventions de gestion des conditions chroniques: 28 156

Traitement et administration des réclamations

Réclamations traitées en 2023: 1 247 890 réclamations totales

Catégorie des réclamations	Volume	Temps de traitement moyen
Réclamations médicales	987,654	3,2 jours
Réclamations sur ordonnance	260,236	1,7 jours

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: Ressources clés

Infrastructure de technologie de santé avancée

Au quatrième trimestre 2023, l'infrastructure technologique d'alignement Healthcare comprend:

Composant technologique	Détails spécifiques
Plateforme de cloud computing	Infrastructure cloud de soins de santé basée sur l'AWS
Investissement informatique annuel	42,7 millions de dollars en 2023
Personnel technologique	287 professionnels de la technologie à temps plein

Expertise clinique et professionnels de la santé

Alignement Composition de la main-d'œuvre clinique de la santé:

• Personnel clinique total: 1 642 professionnels
• Physiciens certifiés au conseil: 412
• Infirmières autorisées: 836
• Coordinateurs de soins spécialisés: 394

Capacités d'analyse des données

Métrique analytique	Valeur quantitative
Capacité de traitement des données	3,7 pétaoctets par mois
Modèles d'apprentissage automatique	47 Algorithmes de soins de santé prédictifs
Points de données des patients en temps réel	Plus de 2,1 millions de dossiers individuels de patients

Plateformes de fiançailles des patients

Métriques d'engagement numérique:

• Utilisateurs d'applications mobiles: 276 000
• Taux de consultation en télésanté: augmentation de 62% en 2023
• Portail patient utilisateurs actifs: 193 000

Algorithmes de gestion des risques propriétaires

Composant de gestion des risques	Spécification quantitative
Modèles de risque prédictifs	23 algorithmes de risque de soins de santé spécialisés
Précision de prédiction de précision	87,4% Taux de prédiction des résultats cliniques
Investissement annuel sur le développement de l'algorithme	8,3 millions de dollars en 2023

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: propositions de valeur

Solutions personnalisées Medicare Advantage

Au quatrième trimestre 2023, Alignment Healthcare a servi 72 500 membres de Medicare Advantage dans 8 États. Les plans Medicare Advantage de la société ont généré 1,87 milliard de dollars de revenus totaux pour l'exercice 2023.

Métrique Medicare Advantage	2023 données
Total des membres	72,500
Revenus totaux	1,87 milliard de dollars
Couverture géographique	8 États

Coordination améliorée des soins aux patients

Alignement Healthcare déployé 245 spécialistes de la coordination des soins dédiés En 2023, la gestion des besoins complexes de soins aux patients avec un temps d'interaction moyen de 37 minutes par cas.

• Taille de l'équipe de coordination des soins: 245 spécialistes
• Temps d'interaction moyen du patient: 37 minutes
• Ratio de gestion des cas complexes: 1:52 spécialiste du patient

Gestion des soins de santé axés sur la technologie

La société a investi 42,3 millions de dollars dans l'infrastructure de technologies de santé numérique en 2023, soutenant l'analyse prédictive avancée et les systèmes de surveillance à distance des patients.

Catégorie d'investissement technologique	2023 dépenses
Infrastructure de santé numérique	42,3 millions de dollars
Développement de l'analyse prédictive	18,7 millions de dollars
Systèmes de surveillance à distance	23,6 millions de dollars

Navigation de santé simplifiée pour les personnes âgées

Le centre de soutien aux membres Alignment Healthcare a traité 214 500 enquêtes de navigation en soins de santé spécifiques aux personnes âgées en 2023, avec un taux de résolution de 92% en premier contact.

• Total des demandes de navigation: 214 500
• Taux de résolution du premier contact: 92%
• Temps de réponse moyen de l'enquête: 12 minutes

Modèles de prestation de soins de santé rentables

En 2023, la société a atteint un ratio de pertes médicales de 85,6%, démontrant l'efficacité de la gestion des coûts des soins de santé dans ses plans Medicare Advantage.

Métrique de gestion des coûts	Performance de 2023
Ratio de perte médicale	85.6%
Coût moyen par membre par mois	$625
Économies de coûts mis en œuvre	47,3 millions de dollars

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: relations avec les clients

Portails de patients numériques

Depuis le quatrième trimestre 2023, le portail numérique des patients numériques d'Alignment Healthcare prend en charge 75 432 utilisateurs actifs dans ses plans Medicare Advantage. Le portail fournit:

• Accès des dossiers de santé en temps réel
• Gestion des ordonnances
• Planification de rendez-vous de la télésanté

Métrique du portail	2023 données
Utilisateurs actifs mensuels	75,432
Taux d'engagement numérique	62.3%
Connects mensuels moyens	4.7 par utilisateur

Équipes de gestion des soins dédiés

Alignement Healthcare Emploie 327 professionnels de la gestion des soins dédiés desservant environ 54 210 membres de Medicare Advantage.

Métrique de gestion des soins	2023 statistiques
Total des gestionnaires de soins	327
Membres moyens par gestionnaire de soins	166
Interactions annuelles de coordination des soins	189,435

Canaux de communication personnalisés

Les stratégies de communication comprennent:

• Notifications SMS: 68% de participation aux membres
• Communications par e-mail: 53% de taux d'ouverture
• Appels vocaux automatisés: taux de réponse 41%

Services de surveillance de la santé proactifs

Alignement Santé surveille 42 567 patients à haut risque Grâce à une analyse de santé prédictive avancée.

Surveillance de la métrique	2023 données
Patients à haut risque surveillés	42,567
Interventions préventives	23,891
Taux de détection précoce	76.4%

Programmes de support client et d'assistance

L'infrastructure de support comprend:

• Centre d'appels multilingues 24/7
• Temps de réponse moyen: 3,2 minutes
• Interactions de soutien annuelles: 214 589

Métrique de soutien	Performance de 2023
Interactions totales de soutien	214,589
Temps de résolution moyen	17,6 minutes
Évaluation de satisfaction du client	88.7%

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: canaux

Plateformes numériques en ligne

Alignment Healthcare utilise sa plate-forme numérique propriétaire AlignedConnect.com, qui dessert environ 54 000 membres de Medicare Advantage au quatrième trimestre 2023.

Métriques de plate-forme numérique	2023 statistiques
Total des utilisateurs numériques	54,000
Utilisateurs actifs mensuels	38,250
Taux d'engagement de la plate-forme numérique	71%

Applications mobiles

L'application mobile de l'entreprise prend en charge les interactions des membres avec les outils de gestion des soins de santé en temps réel.

• Taux de téléchargement des applications mobiles: 22 000 téléchargements annuels
• Taux de rétention des utilisateurs: 68%
• Utilisateurs actifs mensuels moyens: 16 500

Réseaux de courtiers d'assurance

Aligner des partenaires de soins de santé avec 174 Réseaux de courtiers d'assurance indépendants dans 13 États.

Détails du réseau de courtiers	2024 chiffres
Partners du courtier total	174
Couverture géographique	13 États
Volume de référence annuel	37 500 membres

Équipe de vente directe

La société maintient un force de vente directe dédiée Se concentrer sur les marchés de Medicare Advantage.

• Représentants des ventes totales: 285
• Cycle de vente moyen: 45 jours
• Taux de conversion: 24%

Réseaux de référence du fournisseur de soins de santé

Alignment Healthcare collabore avec 2 340 fournisseurs de soins de santé pour les références des membres et la gestion des soins intégrés.

Métriques du réseau des fournisseurs	2024 données
Total des partenaires des fournisseurs	2,340
Volume de référence annuel	42,750
Couverture réseau	13 États

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: segments de clientèle

Seniors éligibles à l'assurance-maladie

Au quatrième trimestre 2023, Alignment Healthcare dessert 61 400 membres de Medicare Advantage en Californie, en Floride, en Caroline du Nord et au Nevada.

État	Membres de Medicare Advantage
Californie	38,640
Floride	12,280
Caroline du Nord	6,140
Nevada	4,340

Les personnes ayant des besoins de soins de santé complexes

Alignement Healthcare se concentre sur les patients à haute complexité souffrant de multiples affections chroniques.

• Nombre moyen de conditions chroniques par patient: 3,7
• Pourcentage de membres ayant des besoins de soins de santé complexes: 42,5%
• Dépenses de santé annuelles pour les patients complexes: 45 670 $ par membre

Bénéficiaires à double Medicare et Medicaid

En 2023, Alignment Healthcare a ciblé les populations à double éligible dans ses régions de service.

Segment double éligible	Total des membres
Medicare-Medicaid Inscriptions	22,510
Pourcentage de l'adhésion totale	36.7%

Aînés à la recherche de solutions de soins de santé complètes

Alignment Healthcare fournit des modèles de soins intégrés aux personnes âgées.

• Âge moyen des membres: 72,3 ans
• Membres avec des plans de soins complets: 58 900
• Coût des soins complets par membre annuel: 12 340 $

Populations de patients à haut risque

L'entreprise gère stratégiquement les segments de patients à haut risque.

Catégorie de risque	Nombre de patients	Pourcentage
Patients à haut risque	26,130	42.6%
Patients à risque moyen	24,560	40.0%
Patients à faible risque	10,710	17.4%

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: Structure des coûts

Investissements infrastructures technologiques

Au quatrième trimestre 2023, Alignment Healthcare a signalé des investissements sur l'infrastructure technologique de 43,2 millions de dollars, ce qui représente 12,5% du total des dépenses d'exploitation.

Catégorie d'investissement technologique	Coût annuel ($)
Infrastructure de cloud computing	18,750,000
Systèmes de cybersécurité	8,640,000
Plateformes d'analyse des soins de santé	15,810,000

Compensation des prestataires de soins de santé

La rémunération des prestataires représente 45,6% du coût opérationnel total, totalisant 276,8 millions de dollars en 2023.

• Remboursement du médecin du réseau: 187,4 millions de dollars
• Frais de consultation spécialisés: 59,2 millions de dollars
• Incitations basées sur la performance: 30,2 millions de dollars

Frais de traitement des réclamations

Les coûts de traitement des réclamations pour 2023 étaient de 62,3 millions de dollars, ce qui représente 10,2% du total des dépenses opérationnelles.

Composant de traitement des réclamations	Coût annuel ($)
Logiciel et technologie	22,430,000
Personnel	34,560,000
Frais généraux administratifs	5,310,000

Coûts de marketing et d'acquisition des clients

Les dépenses de marketing en 2023 ont totalisé 41,7 millions de dollars, avec un coût d'acquisition des clients de 453 $ par membre.

• Marketing numérique: 18,2 millions de dollars
• Publicité traditionnelle: 12,5 millions de dollars
• Compensation de l'équipe de vente: 11 millions de dollars

Conformité réglementaire et frais généraux administratifs

Les frais de conformité et administratifs ont atteint 87,6 millions de dollars en 2023, ce qui représente 14,4% du total des dépenses opérationnelles.

Catégorie de conformité	Coût annuel ($)
Services juridiques et réglementaires	37,200,000
Audit et rapport	22,800,000
Formation de la conformité	27,600,000

Alignment Healthcare, Inc. (ALHC) - Modèle d'entreprise: Strots de revenus

Medicare Advantage Plan Primiums

Pour l'exercice 2023, Alignment Healthcare a déclaré que les primes de plan Medicare Advantage total de 2,26 milliards de dollars. La société dessert environ 59 000 membres de Medicare Advantage dans plusieurs États.

Année	Medicare Advantage Primiums	Couper les membres
2023	2,26 milliards de dollars	59,000
2022	1,98 milliard de dollars	52,000

Remboursements ajustés au risque

En 2023, Alignment Healthcare a reçu 387,4 millions de dollars dans les remboursements ajustés au risque de Medicare.

• Paiement moyen d'ajustement du risque par membre: 6 560 $
• Taux de croissance des revenus d'ajustement des risques: 14,3%

Contrats de soins basés sur la valeur

L'entreprise a généré 214,6 millions de dollars D'après les contrats de soins basés sur la valeur en 2023, représentant 9,5% du total des revenus.

Type de contrat	Revenu	Pourcentage du total des revenus
Contrats à risque complet	156,3 millions de dollars	6.9%
Contrats d'épargne partagés	58,3 millions de dollars	2.6%

Licence de plate-forme technologique

ALIGNAMME Les revenus des licences sur la plate-forme technologique de Healthcare étaient 22,7 millions de dollars en 2023.

Frais de service de gestion des soins

Les frais de service de gestion des soins ont totalisé 45,2 millions de dollars pour l'exercice 2023.

Type de service	Revenu
Services de coordination des soins	28,6 millions de dollars
Gestion des maladies chroniques	16,6 millions de dollars

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

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

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

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

Proactive, Personalized Care That Reduces High-Cost Events

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

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

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

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

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

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

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

Supplemental Benefits Addressing Social Determinants of Health (SDoH)

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

For specific 2025 plans, you see concrete allowances:

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

Finance: draft 13-week cash view by Friday.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Finance: draft 13-week cash view by Friday.

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

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

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

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

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

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

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

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

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

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

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

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

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

Premium revenue from Medicare Advantage health plan members

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

Risk adjustment revenue based on member health status and quality scores

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

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

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

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

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

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

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

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

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

Finance: draft 13-week cash view by Friday.