Elect Health Inc. (ELV): Business Model Canvas [Jan-2025 Mis à jour]

Dans le paysage dynamique de l'assurance-santé, Eleveance Health Inc. (ELV) apparaît comme une puissance transformatrice, redéfinissant la façon dont les Américains accèdent et expérimentent la couverture médicale. Cette entreprise innovante a méticuleusement conçu un modèle commercial qui va au-delà de l'assurance traditionnelle, intégrant des technologies numériques de pointe, des programmes de bien-être complets et des solutions de soins de santé personnalisées. En tirant stratégiquement un vaste réseau de partenariats et une analyse avancée des données, la santé de l'Eleveance n'est pas seulement la vente d'assurance - ils révolutionnent l'ensemble de l'écosystème des soins de santé, ce qui rend les soins médicaux complets, rentables et technologiquement avancés accessibles à des millions de personnes à travers divers segments de clients.

Elevance Health Inc. (ELV) - Modèle commercial: partenariats clés

Fournisseurs de soins de santé et hôpitaux du pays

Elevance Health maintient des partenariats avec environ 106 000 médecins de soins primaires et 510 000 médecins en soins spéciaux en 2023. La société a des relations contractuelles avec plus de 4 700 hôpitaux à l'échelle nationale.

Type de partenariat	Nombre de prestataires	Zone de couverture
Médecins de soins primaires	106,000	À l'échelle nationale
Médecins de soins spécialisés	510,000	À l'échelle nationale
Hôpitaux	4,700	À l'échelle nationale

Gestionnaires de prestations pharmaceutiques (PBM)

Elevance Health possède Ingeniorx, l'un des PBM les plus importants des États-Unis, qui dessert environ 45 millions de membres.

• Part de marché PBM: environ 7,5% du marché PBM total
• Réclamations sur ordonnance traitées chaque année: plus de 1,2 milliard

Partners de la technologie et des solutions de santé numérique

Elevance Health collabore avec plusieurs partenaires technologiques pour améliorer les solutions de soins de santé numériques.

Catégorie de partenaire	Nombre de partenariats	Domaine de mise au point
Plateformes de télésanté	12	Prestation de soins de santé à distance
Solutions de soins de santé AI	8	Analytique prédictive
Surveillance de la santé numérique	15	Engagement des patients

Programmes de soins de santé gouvernementaux

Elevance Health participe à plusieurs programmes gouvernementaux de santé dans différents États.

• Contrats Medicaid: actif dans 19 États
• Medicare Advantage Membres: plus de 2,3 millions
• Total des membres du programme gouvernemental: environ 6,5 millions

Sociétés d'assurance et de réassurance

La santé de l'Elevance maintient des partenariats stratégiques avec de multiples entités d'assurance et de réassurance.

Type de partenariat	Nombre de partenaires	Couverture d'atténuation des risques
Sociétés de réassurance	7	Couverture totale de 5,2 milliards de dollars
Partenaires d'assurance régional	23	Partage des risques à l'échelle nationale

Elevance Health Inc. (ELV) - Modèle d'entreprise: activités clés

Assurance maladie et gestion de la couverture médicale

Elevance Health gère la couverture d'assurance maladie pour environ 47,5 millions de membres dans divers segments en 2023. La société opère dans 14 États avec des plans de couverture médicale complets.

Segment de couverture	Nombre de membres
Assurance commerciale	28,3 millions
Médicament	8,9 millions
Medicaid	10,3 millions

Traitement et administration des réclamations

L'élévation de la santé traite environ 250 millions de réclamations par an avec un taux d'efficacité de traitement numérique de 92%. Le système d'administration des réclamations de l'entreprise gère:

• Réclamations médicales
• Réclamations en pharmacie
• Réclamations dentaires
• Réclamations de vision

Développement du réseau de soins de santé

La société maintient un réseau de 106 000 prestataires de soins de santé et 6 200 hôpitaux dans ses États opérationnels. La composition du réseau comprend:

Type de fournisseur	Nombre
Médecins de soins primaires	48,500
Médecins spécialisés	57,500

Innovation de la technologie de la santé numérique

Elevance Health a investi 782 millions de dollars dans les technologies de santé numérique en 2023. Les investissements technologiques clés comprennent:

• Plateformes de télémédecine
• Systèmes de surveillance de la santé dirigés par l'IA
• Applications de santé mobile
• Intégration des dossiers de santé électronique

Conception du programme de soins du bien-être et des soins préventifs

La société met en œuvre des programmes de bien-être pour 35,6 millions de membres, avec un investissement annuel de 425 millions de dollars dans des initiatives de soins préventifs.

Catégorie de programme	Participants annuels
Gestion des maladies chroniques	12,3 millions
Soutien à la santé mentale	8,7 millions
Programmes de fitness et de nutrition	14,6 millions

Elevance Health Inc. (ELV) - Modèle d'entreprise: Ressources clés

Réseau des fournisseurs de soins de santé étendus

Depuis 2024, Elevance Health maintient un réseau complet de:

Type de fournisseur	Nombre total
Hôpitaux	67,000+
Médecins	106,000+
Pharmacies	64,000+

Plates-formes de santé numériques avancées

L'infrastructure numérique comprend:

• Plateformes de télésanté propriétaires
• Systèmes de surveillance de la santé alimentés par l'IA
• Applications de santé mobile

Métrique de la plate-forme numérique	2024 statistiques
Interactions annuelles sur la santé numérique	42 millions +
Utilisateurs d'applications mobiles	8,3 millions

Capacités d'analyse de données à grande échelle

Ressources d'analyse des données:

• Entrepôt de données de santé propriétaire
• Algorithmes d'apprentissage automatique
• Systèmes de modélisation de la santé prédictive

Métrique d'analyse des données	2024 capacités
Dossiers de soins de santé traités	290 millions +
Capacité de traitement des données annuelle	1,2 pétaoctets

Forte infrastructure financière

Ressources financières à partir de 2024:

Métrique financière	Montant
Revenus totaux	142,5 milliards de dollars
Flux de trésorerie d'exploitation	8,3 milliards de dollars
Actif total	186,7 milliards de dollars

Des équipes de gestion des soins de santé expérimentées

Métrique de gestion	2024 statistiques
Total des employés	116,000+
Expérience de gestion moyenne	17,5 ans

Elevance Health Inc. (ELV) - Modèle d'entreprise: propositions de valeur

Couverture d'assurance maladie complète

Depuis le quatrième trimestre 2023, Elect Health Inc. offre une couverture d'assurance maladie à 47,8 millions de membres dans les segments commerciaux, Medicare et Medicaid. Les primes totales d'assurance maladie de la société ont atteint 117,4 milliards de dollars de revenus annuels pour 2023.

Segment de l'assurance	Nombre de membres	Part de marché
Commercial	24,3 millions	16.2%
Médicament	12,5 millions	11.7%
Medicaid	11 millions	9.5%

Solutions de soins de santé personnalisés

Elevance Health investit 782 millions de dollars par an dans des plateformes de technologie de santé et d'analyse de données personnalisées.

• Évaluation des risques prédictifs dirigés par l'IA
• Programmes de gestion des soins personnalisés
• Recommandations de traitement individualisées

Options de service numérique et de télésanté

Les services de santé numériques représentent 22,4% du total des interactions des patients, avec 8,3 millions de consultations de télésanté effectuées en 2023.

Service de santé numérique	Utilisation annuelle
Consultations de médecin virtuel	5,6 millions
Télésanté de santé mentale	1,7 million
Gestion des maladies chroniques	1 million

Gestion rentable des soins médicaux

La santé de plus en plus réduit les coûts des soins de santé de 14,6% grâce à des stratégies de gestion des soins avancés, ce qui permet d'économiser environ 3,2 milliards de dollars pour les membres en 2023.

Programmes intégrés de bien-être et de soins préventifs

La société exploite 672 centres de bien-être et investit 456 millions de dollars dans des initiatives de soins préventifs, couvrant 35,6% de sa base totale de membres.

• Projections de santé annuelles
• Programmes de prévention des maladies chroniques
• Interventions de gestion du style de vie

Elevance Health Inc. (ELV) - Modèle d'entreprise: relations clients

Portails membres en ligne

Depuis 2024, Elevance Health conserve un portail membre en ligne avec les mesures clés suivantes:

Métrique du portail	Données spécifiques
Membres numériques totaux	4,6 millions d'utilisateurs actifs
Taux de connexion du portail mensuel	62% des membres enregistrés
Transactions en libre-service	3,2 millions de transactions numériques mensuelles

Centres d'assistance au service client

Elevance Health exploite l'infrastructure de support client avec ces spécifications:

• Centres de support client 24/7
• Temps de réponse du centre d'appel moyen: 2,7 minutes
• Volume annuel du support client: 12,4 millions d'interactions
• Prise en charge multicanal, y compris le téléphone, les e-mails et le chat

Plateformes d'engagement d'applications mobiles

Mesures d'engagement des applications mobiles pour 2024:

Métrique de l'application mobile	Données spécifiques
Téléchargements totaux d'applications mobiles	3,8 millions de téléchargements
Utilisateurs actifs mensuels	2,1 millions d'utilisateurs
Durée moyenne de la session d'application	7,4 minutes par session

Outils de gestion de la santé personnalisés

Capitaires personnalisées de la plate-forme de gestion de la santé:

• Évaluations des risques de santé dirigés par l'IA
• Recommandations de bien-être personnalisées
• Programmes de gestion des conditions chroniques
• Services de coaching de santé numérique

Mises à jour régulières de la communication et de la santé

Métriques de performance des canaux de communication:

Canal de communication	Engagement mensuel
Courriel des newsletters de la santé	2,9 millions d'abonnés
Alertes de santé SMS	1,7 million de destinataires actifs
Recommandations de santé personnalisées	3,4 millions de communications ciblées

Elevance Health Inc. (ELV) - Modèle commercial: canaux

Plates-formes numériques et applications mobiles

Elevenance Health exploite le Application mobile Sydney Health, qui dessert plus de 12 millions de membres en 2023. La plate-forme numérique traite environ 3,5 millions d'interactions numériques mensuelles pour les services de santé.

Canal numérique	Utilisateurs actifs mensuels	Fonctions clés
Application Sydney Health	12 millions	Revue des réclamations, recherche de fournisseur, carte d'identité numérique
Portail Web	8,2 millions	Gestion des prestations, inscription

Brokers et agents d'assurance

La santé de l'altitude maintient un réseau de 3 700 courtiers d'assurance sous licence Dans 14 États, générant environ 2,3 milliards de dollars de revenus annuels sur les primes par le biais de canaux de vente indirects.

Équipes de vente directes

L'entreprise emploie 1 200 représentants des ventes dédiées ciblant les marchés individuels et en groupe, avec un volume de ventes annuel moyen de 187 millions de dollars par équipe de vente.

Catégorie de vente	Taille de l'équipe	Revenus annuels
Marché individuel	650 représentants	1,1 milliard de dollars
Marché des groupes	550 représentants	1,2 milliard de dollars

Programmes d'inscription du groupe des employeurs

La santé de l'altitude sert Plus de 46 000 groupes d'employeurs, couvrant environ 16,5 millions de membres par le biais de plans de soins de santé des entreprises.

• Segment des petites entreprises: 28 000 employeurs
• Segment du marché intermédiaire: 12 500 employeurs
• Grand segment d'entreprise: 5 500 employeurs

Marketing en ligne et portails Web

La société investit 124 millions de dollars par an dans le marketing numérique, générant 2,6 millions de conversions en ligne à travers les gammes de produits de santé.

Canal de marketing	Investissement annuel	Taux de conversion
Publicité numérique payante	78 millions de dollars	1,4 million de conversions
Marketing Web biologique	46 millions de dollars	1,2 million de conversions

Elevance Health Inc. (ELV) - Modèle d'entreprise: segments de clientèle

Consommateurs d'assurance maladie individuels

Depuis 2023, Elevance Health dessert environ 47,8 millions de consommateurs individuels d'assurance maladie dans plusieurs États. La ventilation de la clientèle comprend:

Groupe d'âge	Nombre de consommateurs	Pourcentage
18-34 ans	12,3 millions	25.7%
35 à 54 ans	18,5 millions	38.7%
Plus de 55 ans	17 millions	35.6%

Groupes d'entreprises et d'employeurs

Elevance Health offre une couverture d'assurance maladie à 16,2 millions d'employés dans divers secteurs.

Secteur de l'industrie	Nombre d'employés couverts
Technologie	3,4 millions
Fabrication	2,9 millions
Soins de santé	2,7 millions
Vente au détail	2,5 millions
Autres secteurs	4,7 millions

Bénéficiaires Medicare et Medicaid

Total des bénéficiaires de Medicare et de Medicaid servis: 14,6 millions

• Inscriptions de Medicare Advantage: 8,3 millions
• Medicaid Managed Care Inscrits: 6,3 millions

Petites et moyennes entreprises commerciales

La santé de l'Eleve Couvre 1,2 million de petites et moyennes entreprises à travers les États-Unis.

Taille de l'entreprise	Nombre d'entreprises	Employés moyens par entreprise
Petites entreprises (10-50 employés)	780,000	25
Entreprises moyennes (51-500 employés)	420,000	150

Professionnels indépendants

Elevance Health dessert 2,1 millions de professionnels indépendants dans divers secteurs.

• Les pigistes: 1,2 million
• Entrepreneurs indépendants: 580 000
• Propriétaires de petites entreprises: 320 000

Elevance Health Inc. (ELV) - Modèle d'entreprise: Structure des coûts

Maintenance du réseau des fournisseurs de soins de santé

En 2023, Eleveance Health Inc. a déclaré des frais de maintenance du réseau de 4,2 milliards de dollars. La répartition des coûts comprend:

Catégorie de dépenses	Montant (millions de dollars)
Négociations de contrats de fournisseur	1,350
Accréditation du réseau	620
Gestion des performances du fournisseur	780

Frais de traitement des réclamations

Les coûts de traitement des réclamations pour la santé de l'allée en 2023 ont totalisé 2,8 milliards de dollars.

• Infrastructure de traitement des réclamations numériques: 890 millions de dollars
• Revue des réclamations manuelles: 650 millions de dollars
• Réclamations Systèmes de détection de fraude: 420 millions de dollars

Technologie et infrastructure numérique

L'investissement technologique pour 2023 a atteint 1,6 milliard de dollars.

Segment technologique	Dépenses (millions de dollars)
Cloud computing	520
Cybersécurité	340
Plateformes de santé numérique	450

Coûts administratifs et opérationnels

Les dépenses administratives pour 2023 étaient de 3,5 milliards de dollars.

• Pridifaire des entreprises: 1,2 milliard de dollars
• Ressources humaines: 620 millions de dollars
• Compliance et rapport réglementaire: 540 millions de dollars

Frais de marketing et d'acquisition des clients

Les dépenses de marketing pour 2023 ont totalisé 1,1 milliard de dollars.

Canal de marketing	Dépenses (millions de dollars)
Marketing numérique	420
Publicité traditionnelle	350
Coûts des représentants commerciaux	330

Elevance Health Inc. (ELV) - Modèle d'entreprise: Strots de revenus

Primes d'assurance maladie

Revenus de primes d'assurance maladie totale pour Elect Health Inc. en 2022: 117,7 milliards de dollars

Segment	Revenus premium (2022)
Assurance commerciale	48,3 milliards de dollars
Médicament	35,6 milliards de dollars
Medicaid	33,8 milliards de dollars

Remboursements du programme de soins de santé du gouvernement

Remboursements totaux de santé du gouvernement en 2022: 69,4 milliards de dollars

• Remboursements de Medicare Advantage: 42,1 milliards de dollars
• Remboursements de soins gérés Medicaid: 27,3 milliards de dollars

Frais de programme de bien-être

Revenus du programme de bien-être en 2022: 1,2 milliard de dollars

Frais de service de santé numérique

Revenus de services de santé numérique en 2022: 780 millions de dollars

Type de service numérique	Revenu
Services de télésanté	420 millions de dollars
Surveillance à distance des patients	210 millions de dollars
Gestion des soins numériques	150 millions de dollars

Revenus de gestion des avantages en pharmacie

Revenus de gestion des prestations en pharmacie en 2022: 24,6 milliards de dollars

• Traitement des réclamations sur les médicaments sur ordonnance: 18,3 milliards de dollars
• Gestion des réseaux de pharmacie: 4,2 milliards de dollars
• Services de prix et de remise des médicaments: 2,1 milliards de dollars

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.