Humana Inc. (HUM): Business Model Canvas [Jan-2025 Mise à jour]

Dans le paysage dynamique de l'assurance santé, Humana Inc. est une force transformatrice, réinvenant la façon dont les Américains accèdent et éprouvent une couverture médicale. Avec un modèle commercial stratégique qui mélange de manière transparente une technologie innovante, une gestion des soins complète et des solutions centrées sur le client, Humana s'est positionné comme un écosystème de santé pionnier qui va au-delà des paradigmes d'assurance traditionnels. En tirant parti des plates-formes numériques avancées, des réseaux de fournisseurs étendus et des programmes de bien-être personnalisés, la société ne vend pas seulement des assurances - il élabore des expériences de soins de santé holistiques qui permettent aux membres de Medicare, Medicaid et des régimes individuels de prendre le contrôle de leur bien-être.

Humana Inc. (HUM) - Modèle d'entreprise: partenariats clés

Fournisseurs de soins de santé et réseaux hospitaliers

Humana a des partenariats avec 67 600 médecins de soins primaires et 430 000 spécialistes à travers les États-Unis à partir de 2023. La société maintient des collaborations stratégiques avec environ 3 800 hôpitaux à l'échelle nationale.

Type de partenaire	Nombre de partenaires	Zone de couverture
Médecins de soins primaires	67,600	À l'échelle nationale
Médecins spécialisés	430,000	À l'échelle nationale
Hôpitaux	3,800	À l'échelle nationale

Réseaux de plan Medicare Advantage

Humana opère dans 49 États avec des plans Medicare Advantage, desservant 5,3 millions de membres de Medicare Advantage au quatrième trimestre 2023.

Gestionnaires de prestations de pharmacie

Humana collabore avec les partenaires de la gestion des avantages sociaux multiples (PBM) pour optimiser les services de médicaments sur ordonnance.

• Partenaire PBM primaire: Humana Pharmacy Solutions
• Couverture du réseau: plus de 68 000 pharmacies de vente au détail
• Volume de prescription: environ 300 millions d'ordonnances traitées chaque année

Partners de la technologie et des solutions de santé numérique

Humana investit 1,2 milliard de dollars par an dans les innovations technologiques et de santé numérique. Les partenariats technologiques clés comprennent:

Partenaire technologique	Domaine de mise au point	Année de partenariat
Google Cloud	Analyse des données sur les soins de santé	2021
Santé Teladoc	Services de télésanté	2019
Pomme	Surveillance de la santé numérique	2020

Sociétés d'assurance et de réassurance

Humana maintient des accords de réassurance couvrant environ 8,5 milliards de dollars de transfert de risque potentiel en 2023.

Partenaire de réassurance	Montant de la couverture des risques	Type de couverture
Suisse re	3,2 milliards de dollars	Réclamations médicales
Munich re	2,7 milliards de dollars	Vie et handicap
Hanover re	2,6 milliards de dollars	Santé complète

Humana Inc. (HUM) - Modèle d'entreprise: activités clés

Assurance des soins de santé et gestion de la couverture

Depuis 2024, Humana gère approximativement 4,9 millions de membres de Medicare Advantage. La société traite un estimé 185 millions de réclamations de soins de santé par an.

Segment de l'assurance	Couper les membres	Réclamations annuelles traitées
Avantage Medicare	4,9 millions	185 millions

Administration des services Medicare et Medicaid

Humana opère dans 44 États pour les services Medicare, avec un 22,4 milliards de dollars de revenus des segments gouvernementaux en 2023.

• Part de marché de Medicare Advantage: 8%
• Medicaux Medicald Care Membres: 1,2 million

Gestion des prestations de pharmacie

Les services de pharmacie de l'humana gèrent 54,3 milliards de dollars en frais de médicaments sur ordonnance annuellement.

Métriques de pharmacie	Valeur annuelle
Coûts de médicaments sur ordonnance gérés	54,3 milliards de dollars
Taille du réseau de pharmacie	67 000 pharmacies

Développement de la technologie de la santé numérique

Humana a investi 486 millions de dollars de technologie et d'innovation En 2023, en vous concentrant sur la télésanté et les plateformes de surveillance à distance.

• Plateformes de santé numérique: 3 plateformes primaires
• Interactions de télésanté: 2,7 millions de consultations annuelles

Programmes de coordination et de bien-être des soins

Humana gère Plus de 500 programmes de bien-être et de soins préventifs, servant environ 5,3 millions de participants.

Métriques du programme de bien-être	Compter / participants
Programmes totaux de bien-être	500+
Participants du programme	5,3 millions

Humana Inc. (HUM) - Modèle d'entreprise: Ressources clés

Réseau des fournisseurs de soins de santé étendus

En 2024, Humana maintient un réseau d'environ 455 000 prestataires de soins de santé aux États-Unis. Le réseau comprend:

Type de fournisseur	Nombre de prestataires
Médecins de soins primaires	87,300
Spécialistes	193,500
Hôpitaux	4,800
Pharmacies	169,400

Capacités avancées d'analyse des données

L'infrastructure d'analyse de données de Humana comprend:

• Plus de 20 pétaoctets de données de santé traitées chaque année
• Algorithmes d'apprentissage automatique analysant les modèles de santé des patients
• Plateformes de modélisation prédictives couvrant 14 millions de dossiers individuels de patients

Plateformes de santé numérique et infrastructure technologique

Détails de l'investissement technologique:

Catégorie de technologie	Montant d'investissement (2024)
Plateformes de santé numérique	342 millions de dollars
Infrastructure de cybersécurité	127 millions de dollars
Technologies de télésanté	89 millions de dollars

Capital financier solide et réserves

Ressources financières au quatrième trimestre 2023:

• Actif total: 75,3 milliards de dollars
• Equivalents en espèces et en espèces: 4,2 milliards de dollars
• Total des capitaux propres des actionnaires: 18,6 milliards de dollars

Des équipes de gestion des soins de santé expérimentées

Métrique de gestion	Statistique
Expérience moyenne de soins de santé exécutive	22,4 ans
Haute haute direction avec des diplômes avancés	87%
Promotions internes aux rôles de leadership	63%

Humana Inc. (HUM) - Modèle d'entreprise: propositions de valeur

Options complètes de couverture des soins de santé

Humana offre une couverture de santé avec 92,1 milliards de dollars de revenus totaux en 2022. Les plans de Medicare Advantage ont couvert 5,3 millions de membres au quatrième trimestre 2022.

Type de couverture	Couper les membres	Prime annuelle
Avantage Medicare	5,3 millions	6 780 $ par membre
Assurance commerciale	1,2 million	5 400 $ par membre
Medicaid	1,8 million	4 200 $ par membre

Solutions de Medicare et Medicaid personnalisées

Humana fournit des solutions spécialisées de Medicare avec une cote de satisfaction client de 87%.

• Plans de compléments Medicare
• Couverture d'ordonnance Medicare Part D
• Medicare Advantage Plans de besoins spéciaux

Services de gestion des soins intégrés

La gestion des soins intégrés génère 3,2 milliards de dollars de revenus annuels avec une efficacité de coordination des soins de 92%.

Capacités de santé numérique et de télémédecine

La plate-forme de santé numérique prend en charge 2,4 millions de consultations virtuelles en 2022, ce qui représente une croissance de 18% sur toute l'année.

Métrique de télémédecine	2022 données
Consultations virtuelles	2,4 millions
Utilisateurs de la plate-forme de santé numérique	1,6 million

Programmes de bien-être préventif et de gestion des maladies chroniques

Les programmes de gestion des maladies chroniques servent 3,1 millions de membres avec 1,5 milliard de dollars investis chaque année.

• Programme de gestion du diabète
• Prévention des maladies cardiaques
• Services de gestion du poids

Humana Inc. (HUM) - Modèle d'entreprise: relations clients

Portails membres en ligne et applications mobiles

En 2024, les plateformes numériques de Humana desservent environ 5,3 millions d'utilisateurs numériques actifs. L'application mobile MyHumana a été téléchargée plus de 2,1 millions de fois, avec une cote d'utilisateurs de 4,6 / 5.

Métrique de la plate-forme numérique	2024 statistiques
Utilisateurs numériques actifs	5,3 millions
Téléchargements d'applications mobiles	2,1 millions
Note utilisateur de l'application mobile	4.6/5

Centres de support client 24/7

Humana opère 17 centres de support client à l'échelle nationale, gérant environ 3,8 millions d'interactions clients par mois.

• Temps de résolution moyenne des appels: 8,2 minutes
• Taux de satisfaction client: 89%
• Support multilingue disponible en 6 langues

Services de coaching de santé personnalisés

En 2024, Humana fournit un coaching de santé personnalisé à 672 000 membres, avec une durée d'engagement moyenne de 6,4 mois par participant.

Métrique de coaching de santé	2024 données
Les membres recevant un coaching	672,000
Durée de coaching moyenne	6,4 mois

Évaluations régulières des risques pour la santé

Humana effectue des évaluations des risques pour la santé pour 1,9 million de membres par an, avec un taux d'achèvement de 73%.

• Taux d'achèvement de l'évaluation: 73%
• Temps d'évaluation moyen: 22 minutes
• Options d'évaluation numérique: 64% des évaluations

Programmes d'éducation à la santé communautaire

Humana soutient 287 initiatives d'éducation à la santé communautaire dans 42 États, atteignant environ 1,1 million de participants en 2024.

Métrique du programme communautaire	2024 statistiques
Initiatives communautaires	287
États couverts	42
Participants du programme	1,1 million

Humana Inc. (HUM) - Modèle d'entreprise: canaux

Plates-formes numériques et applications mobiles

Les canaux numériques de Humana comprennent:

• Application mobile MyHumana avec 2,3 millions d'utilisateurs actifs au quatrième trimestre 2023
• Portail de patients en ligne avec 4,7 millions d'utilisateurs enregistrés
• Services de télésanté soutenant 1,2 million de consultations virtuelles par an

Plate-forme numérique	Métriques des utilisateurs	Engagement annuel
Application mobile Myhumana	2,3 millions d'utilisateurs actifs	8,6 millions d'interactions totales
Portail de patients en ligne	4,7 millions d'utilisateurs enregistrés	15,3 millions de connexions annuelles

Représentants des ventes directes

Humana maintient une force de vente directe de 3 742 représentants d'assurance dévoués à partir de 2024.

• Productivité du représentant des ventes moyennes: 1,2 million de dollars de revenus annuels
• Couverture géographique dans 50 États
• Équipes spécialisées pour les marchés Medicare, commerciaux et individuels

Brokers et agents d'assurance

Le réseau de courtier de Humana comprend:

• 17 500 agents d'assurance indépendants contractuels
• Structure de la commission allant de 3 à 8% par politique
• Revenus annuels générés par le courtier: 2,4 milliards de dollars

Partenariats de groupes d'employeurs

Catégorie de partenariat	Nombre de partenariats	Vies couvertes
Grands employeurs (plus de 1000 employés)	423 partenariats	1,6 million de vies couvertes
Employeurs de taille moyenne (100-999 employés)	1 872 partenariats	2,3 millions de vies couvertes

Sites Web de marketing et de comparaison en ligne

Investissements de canaux de marketing numérique:

• Budget annuel du marketing numérique: 87,6 millions de dollars
• Partenariats avec 12 plateformes de comparaison d'assurance majeures
• Dépenses publicitaires numériques ciblées: 42,3 millions de dollars

Canal en ligne	Portée annuelle	Taux de conversion
Google AdWords	3,2 millions d'impressions	4.7%
Sites de comparaison d'assurance	2,8 millions de visiteurs uniques	3.9%

Humana Inc. (HUM) - Modèle d'entreprise: segments de clients

Individus éligibles à l'assurance-maladie

En 2023, Humana dessert environ 5,3 millions de membres de Medicare Advantage. Le segment Medicare de l'entreprise représente un segment de clientèle critique avec la ventilation suivante:

Métrique du segment Medicare	Données quantitatives
Membres totaux de Medicare Advantage	5,3 millions
Medicare Supplement Assurance Inscriptions	1,2 million
Medicare Part D Plan de médicaments sur ordonnance	3,8 millions

Récipiendaires de Medicaid

Le segment Medicaid de Humana se concentre sur les services de santé basés sur l'État:

• Membres totaux de Medicaid: 1,1 million
• Opérationnel dans 18 États
• Vie de Medicaid gérée: 756 000

Consommateurs de soins de santé seniors

Humana cible spécifiquement les personnes âgées avec des solutions de soins de santé spécialisées:

Métriques de santé seniors	Données quantitatives
65+ groupe d'âge couvert	4,9 millions d'individus
Plans de soins de santé spécifiques aux personnes âgées	42 Configurations de plan différentes

Plan de santé du groupe des employeurs

Le segment commercial de Humana comprend des solutions complètes de santé des employeurs:

• Membres totaux du groupe des employeurs: 2,6 millions
• Part de marché en petit groupe: 7,2%
• Couverture du marché en grand groupe: 1,4 million de membres

Demandeurs d'assurance maladie individuels

Détails du segment du marché individuel:

Métriques du marché individuel	Données quantitatives
Total des membres du marché individuel	853,000
Participants sur le marché ACA	412,000
INSCRIPTIONS D'ASSURANCE NON-groupe	441,000

Humana Inc. (HUM) - Modèle d'entreprise: Structure des coûts

Remboursements des services de santé

En 2023, les coûts de remboursement des services de santé totaux de Humana étaient d'environ 61,4 milliards de dollars. La ventilation des dépenses de remboursement comprend:

Catégorie de remboursement	Coût ($)
Réclamations Medicare Advantage	42,3 milliards
Réclamations d'assurance commerciale	12,7 milliards
Remboursements de Medicaid	6,4 milliards

Investissements technologiques et infrastructures

Les investissements technologiques et d'infrastructures de Humana pour 2023 ont totalisé 1,2 milliard de dollars, avec des allocations spécifiques:

• Plateformes de santé numérique: 425 millions de dollars
• Infrastructure de cloud computing: 310 millions de dollars
• Systèmes de cybersécurité: 215 millions de dollars
• Systèmes d'analyse de données: 250 millions de dollars

Compensation et avantages sociaux des employés

Les dépenses totales liées aux employés en 2023 étaient de 8,6 milliards de dollars, structurées comme suit:

Catégorie de compensation	Coût ($)
Salaires de base	5,4 milliards
Avantages sociaux	1,7 milliard
Contributions à la retraite	680 millions
Bonus de performance	820 millions

Frais de marketing et d'acquisition des clients

Les dépenses de marketing pour 2023 s'élevaient à 1,5 milliard de dollars, réparties entre les canaux:

• Marketing numérique: 520 millions de dollars
• Publicité traditionnelle: 410 millions de dollars
• Commissions des ventes directes: 370 millions de dollars
• Programmes de rétention de la clientèle: 200 millions de dollars

Compliance réglementaire et frais administratifs

Les frais de conformité et d'administration en 2023 étaient de 2,3 milliards de dollars, avec l'allocation suivante:

Catégorie de conformité	Coût ($)
Conformité juridique et réglementaire	850 millions
Frais généraux administratifs	740 millions
Audit et gestion des risques	410 millions
Rapports et documentation	300 millions

Humana Inc. (HUM) - Modèle commercial: Strots de revenus

Medicare Advantage Plan Primiums

Pour l'exercice 2023, le segment Medicare Advantage de Humana a généré 23,4 milliards de dollars de revenus premium. La société a déclaré 5,3 millions de membres Medicare Advantage au 31 décembre 2023.

Année	Medicare Advantage Primiums	Total des membres
2023	23,4 milliards de dollars	5,3 millions

Contrats de service Medicaid

Le segment Medicaid de Humana a généré 5,2 milliards de dollars de revenus pour 2023, desservant environ 1,1 million de membres de Medicaid dans plusieurs États.

Frais de gestion des avantages en pharmacie

Les revenus des services de pharmacie pour 2023 ont atteint 16,8 milliards de dollars, avec Frais de gestion des avantages sociaux (PBM) contribuant de manière significative à ce total.

Catégorie de service PBM	Revenus (2023)
Traitement sur ordonnance	4,6 milliards de dollars
Gestion du réseau	3,2 milliards de dollars

Revenus de services de technologie de la santé

Les services de technologie de santé de Humana ont généré 780 millions de dollars de revenus pour 2023, en se concentrant sur les plateformes de santé numérique et les technologies de coordination des soins.

• Services de télésanté: 245 millions de dollars
• Logiciel de gestion des soins: 335 millions de dollars
• Plateformes de santé numérique: 200 millions de dollars

Ventes de produits d'assurance complémentaire

Les revenus des produits d'assurance supplémentaires ont totalisé 2,1 milliards de dollars en 2023, notamment le supplément Medicare et les offres d'assurance dentaire.

Produit supplémentaire	Revenus (2023)
Supplément Medicare	1,4 milliard de dollars
Assurance dentaire	420 millions de dollars
Assurance visuelle	280 millions de dollars

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.