Alinhamento Healthcare, Inc. (ALHC): Modelo de negócios Canvas [Jan-2025 Atualizado]

No cenário em rápida evolução da inovação em saúde, o Alignment Healthcare, Inc. (ALHC) surge como uma força transformadora, reimaginando as soluções do Medicare Advantage por meio de uma abordagem sofisticada e orientada pela tecnologia. Ao elaborar meticulosamente um modelo de negócios que integra perfeitamente o atendimento personalizado do paciente, a análise de dados avançada e o gerenciamento abrangente de assistência médica, a ALHC está na vanguarda da entrega econômico e centrado no paciente Experiências de saúde para idosos. Esse plano estratégico não apenas atende às necessidades complexas das populações elegíveis ao Medicare, mas também representa uma mudança de paradigma na maneira como os serviços de saúde são conceituados, entregues e otimizados no ecossistema médico moderno.

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: Parcerias -chave

Planos de saúde do Medicare Advantage

O alinhamento Healthcare faz parceria com vários planos do Medicare Advantage, incluindo:

Plano de parceiro	Tipo de contrato	Cobertura de mercado
Vantagem do UnitedHealthcare Medicare	Contrato baseado em risco	Califórnia, Flórida, Nevada
Humana Medicare Vantagem	Contrato baseado em valor	Selecione mercados nos EUA ocidentais

Provedores de saúde e grupos médicos

As principais parcerias de provedores incluem:

• Memorial Care Medical Group
• Rede Médica Cedars-Sinai
• Providence Health Plans

Fornecedores de tecnologia e software

Fornecedor	Solução tecnológica	Valor anual do contrato
Sistemas épicos	Registros eletrônicos de saúde	US $ 3,2 milhões
Salesforce	Gerenciamento de relacionamento com o cliente	US $ 1,7 milhão

Analytics de dados e empresas de gerenciamento de riscos

Alinhamento Healthcare colabora com parceiros especializados de análise de dados:

• IBM Watson Health
• Analytics Optum
• Catalisador de Saúde

Corretores de seguros e consultores

Parceiro	Especialidade	Alcance geográfico
Aon Hewitt	Consultoria de benefícios dos funcionários	Nacional
Willis Towers Watson	Gerenciamento de riscos em saúde	Multi-Estado

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: Atividades -chave

Gerenciamento do Plano de Advações do Medicare

A partir do quarto trimestre 2023, o Alinhamento Healthcare administrou 60.342 membros do Medicare Advantage em 10 estados.

Cobertura do estado	Número de membros	Penetração de mercado
Califórnia	42,185	69.9%
Flórida	8,756	14.5%
Outros estados	9,401	15.6%

Coordenação de cuidados e apoio do paciente

Em 2023, o alinhamento da assistência médica implantou 237 especialistas em coordenação de assistência.

• Razão média do paciente-especialista: 1: 256
• Horário de suporte telefônico: 20h às 20h EST
• Interações anuais de coordenação de cuidados: 412.675

Desenvolvimento da plataforma de tecnologia

Investimento de P&D em 2023: US $ 24,3 milhões

Área de foco em tecnologia	Investimento	Estágio de desenvolvimento
Gerenciamento de cuidados orientado a IA	US $ 8,7 milhões	Protótipo avançado
Plataforma de análise preditiva	US $ 6,2 milhões	Produção
Engajamento digital do paciente	US $ 9,4 milhões	Escala

Estratificação de risco e gestão da saúde da população

A análise de gerenciamento de riscos abordou 60.342 pacientes vive em 2023.

• Taxa de identificação de pacientes de alto risco: 22,4%
• Precisão de modelagem de risco preditiva: 87,6%
• Intervenções de gerenciamento de condições crônicas: 28.156

Processamento e administração de reivindicações

Reivindicações processadas em 2023: 1.247.890 reivindicações totais

Categoria de reivindicações	Volume	Tempo médio de processamento
Reivindicações médicas	987,654	3,2 dias
Reivindicações de prescrição	260,236	1,7 dias

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: Recursos -chave

Infraestrutura avançada de tecnologia de saúde

A partir do quarto trimestre 2023, a infraestrutura tecnológica da Alinhamento Healthcare inclui:

Componente de tecnologia	Detalhes específicos
Plataforma de computação em nuvem	Infraestrutura em nuvem de saúde baseada na AWS
Investimento anual de TI	US $ 42,7 milhões em 2023
Equipe de tecnologia	287 profissionais de tecnologia em tempo integral

Experiência clínica e profissionais médicos

Composição da força de trabalho clínica do alinhamento da saúde:

• Equipe clínica total: 1.642 profissionais
• Médicos certificados pelo conselho: 412
• Enfermeiras registradas: 836
• Coordenadores de cuidados especializados: 394

Recursos de análise de dados

Métrica de análise	Valor quantitativo
Capacidade de processamento de dados	3,7 petabytes por mês
Modelos de aprendizado de máquina	47 algoritmos preditivos de saúde
Pontos de dados do paciente em tempo real	Mais de 2,1 milhões de registros individuais de pacientes

Plataformas de engajamento do paciente

Métricas de engajamento digital:

• Usuários de aplicativos móveis: 276.000
• Taxa de consulta de telessaúde: aumento de 62% em 2023
• Usuários ativos do portal de pacientes: 193.000

Algoritmos de gerenciamento de riscos proprietários

Componente de gerenciamento de riscos	Especificação quantitativa
Modelos de risco preditivos	23 algoritmos especializados de risco de saúde
Precisão da previsão de precisão	87,4% da taxa de previsão de resultados clínicos
Investimento anual de desenvolvimento de algoritmos	US $ 8,3 milhões em 2023

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: proposições de valor

Soluções personalizadas do Medicare Advantage

A partir do quarto trimestre 2023, o alinhamento da assistência médica atendeu a 72.500 membros do Medicare Advantage em 8 estados. Os planos do Medicare Advantage da empresa geraram US $ 1,87 bilhão em receita total para o ano fiscal de 2023.

Métrico do Medicare Advantage	2023 dados
Total de membros	72,500
Receita total	US $ 1,87 bilhão
Cobertura geográfica	8 estados

Coordenação aprimorada de atendimento ao paciente

Alinhamento de saúde implantado 245 especialistas em coordenação de cuidados dedicados Em 2023, gerenciar necessidades complexas de atendimento ao paciente com um tempo médio de interação do paciente de 37 minutos por caso.

• Tamanho da equipe de coordenação de atendimento: 245 especialistas
• Tempo médio de interação do paciente: 37 minutos
• Taxa complexa de gerenciamento de casos: 1:52 Especialista para paciente

Gerenciamento de saúde orientado a tecnologia

A empresa investiu US $ 42,3 milhões em infraestrutura de tecnologia de saúde digital em 2023, apoiando análises preditivas avançadas e sistemas de monitoramento remoto de pacientes.

Categoria de investimento em tecnologia	2023 gastos
Infraestrutura de saúde digital	US $ 42,3 milhões
Desenvolvimento de análise preditiva	US $ 18,7 milhões
Sistemas de monitoramento remoto	US $ 23,6 milhões

Navegação simplificada de saúde para idosos

O Centro de Apoio aos Membros da Alinhamento da Saúde processou 214.500 consultas de navegação de assistência médica específicas para a saúde em 2023, com uma taxa de resolução de primeiro contato de 92%.

• Total de perguntas de navegação: 214.500
• Taxa de resolução do primeiro contato: 92%
• Tempo médio de resposta à consulta: 12 minutos

Modelos de prestação de serviços de saúde econômicos

Em 2023, a empresa alcançou uma taxa de perda médica de 85,6%, demonstrando eficiência no gerenciamento de custos de saúde em seus planos do Medicare Advantage.

Métrica de gerenciamento de custos	2023 desempenho
Taxa de perda médica	85.6%
Média por membro por mês	$625
Economia de custos implementada	US $ 47,3 milhões

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: relacionamentos com o cliente

Portais de pacientes digitais

A partir do quarto trimestre 2023, o portal de pacientes digitais da Alinhamento Healthcare suporta 75.432 usuários ativos em seus planos do Medicare Advantage. O portal fornece:

• Acesso ao registro de saúde em tempo real
• Gerenciamento de prescrição
• Programação de compromisso de telessaúde

Métrica portal	2023 dados
Usuários ativos mensais	75,432
Taxa de engajamento digital	62.3%
Logins mensais médios	4.7 por usuário

Equipes de gerenciamento de cuidados dedicados

Empregados de saúde de alinhamento 327 profissionais de gerenciamento de cuidados dedicados Servindo aproximadamente 54.210 membros do Medicare Advantage.

Métrica de gerenciamento de cuidados	2023 Estatísticas
Gerentes de cuidados totais	327
Membros médios por gerente de assistência	166
Interações anuais de coordenação de cuidados	189,435

Canais de comunicação personalizados

As estratégias de comunicação incluem:

• Notificações de SMS: 68% de participação dos membros
• Comunicações por e -mail: 53% de taxa de abertura
• Chamadas de voz automatizadas: taxa de resposta de 41%

Serviços proativos de monitoramento de saúde

Alinhamento de saúde monitora 42.567 pacientes de alto risco por meio de análise de saúde preditiva avançada.

Monitoramento métrica	2023 dados
Pacientes de alto risco monitorados	42,567
Intervenções preventivas	23,891
Taxa de detecção precoce	76.4%

Programas de suporte e assistência ao cliente

A infraestrutura de suporte inclui:

• 24/7 de call center multilíngue
• Tempo médio de resposta: 3,2 minutos
• Interações anuais de suporte: 214.589

Métrica de suporte	2023 desempenho
Interações de suporte total	214,589
Tempo médio de resolução	17,6 minutos
Classificação de satisfação do cliente	88.7%

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: canais

Plataformas digitais online

O Alinhamento Healthcare utiliza sua plataforma digital proprietária AlignedConnect.com, que atende aproximadamente 54.000 membros do Medicare Advantage a partir do quarto trimestre 2023.

Métricas de plataforma digital	2023 Estatísticas
Total de usuários digitais	54,000
Usuários ativos mensais	38,250
Taxa de engajamento da plataforma digital	71%

Aplicativos móveis

O aplicativo móvel da empresa suporta interações com membros com ferramentas de gerenciamento de assistência médica em tempo real.

• Taxa de download de aplicativos móveis: 22.000 downloads anuais
• Taxa de retenção de usuários: 68%
• Usuários ativos mensais médios: 16.500

Redes de corretoras de seguros

Alinhamento Healthcare Partners com 174 Redes de corretor de seguros independentes em 13 estados.

Detalhes da rede de corretores	2024 Figuras
Total Broker Partners	174
Cobertura geográfica	13 estados
Volume anual de referência	37.500 membros

Equipe de vendas diretas

A empresa mantém um Força de vendas direta dedicada focando nos mercados do Medicare Advantage.

• Total de Representantes de Vendas: 285
• Ciclo médio de vendas: 45 dias
• Taxa de conversão: 24%

Redes de referência de prestadores de serviços de saúde

Alinhamento de saúde colabora com 2.340 prestadores de serviços de saúde para referências de membros e gerenciamento de atendimento integrado.

Métricas de rede de provedores	2024 dados
TOTAL DE PROVEDOR PARCEIROS	2,340
Volume anual de referência	42,750
Cobertura de rede	13 estados

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: segmentos de clientes

Idosos elegíveis para o Medicare

No quarto trimestre 2023, o alinhamento de assistência médica atende 61.400 membros do Medicare Advantage em toda a Califórnia, Flórida, Carolina do Norte e Nevada.

Estado	Membros do Medicare Advantage
Califórnia	38,640
Flórida	12,280
Carolina do Norte	6,140
Nevada	4,340

Indivíduos com necessidades complexas de saúde

O alinhamento da saúde se concentra em pacientes com alta complexidade com múltiplas condições crônicas.

• Número médio de condições crônicas por paciente: 3.7
• Porcentagem de membros com necessidades complexas de saúde: 42,5%
• Gastos anuais em saúde para pacientes complexos: US $ 45.670 por membro

Beneficiários com dupla elegível Medicare e Medicaid

Em 2023, a assistência médica de alinhamento direcionou populações duplas elegíveis em suas regiões de serviço.

Segmento duplo elegível	Total de membros
Medicare-Medicaid Instrollees	22,510
Porcentagem de membros totais	36.7%

Idosos que buscam soluções abrangentes de saúde

O alinhamento de assistência médica fornece modelos de atendimento integrado para idosos.

• Idade média dos membros: 72,3 anos
• Membros com planos de terapia abrangente: 58.900
• Custo anual de terapia abrangente por membro: US $ 12.340

Populações de pacientes de alto risco

A empresa gerencia estrategicamente segmentos de pacientes de alto risco.

Categoria de risco	Número de pacientes	Percentagem
Pacientes de alto risco	26,130	42.6%
Pacientes de médio risco	24,560	40.0%
Pacientes de baixo risco	10,710	17.4%

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: estrutura de custos

Investimentos de infraestrutura de tecnologia

A partir do quarto trimestre 2023, a Alinhamento Healthcare relatou investimentos em infraestrutura de tecnologia de US $ 43,2 milhões, representando 12,5% do total de despesas operacionais.

Categoria de investimento em tecnologia	Custo anual ($)
Infraestrutura de computação em nuvem	18,750,000
Sistemas de segurança cibernética	8,640,000
Plataformas de análise de saúde	15,810,000

Compensação do provedor de assistência médica

A compensação do provedor representa 45,6% do total de custos operacionais, totalizando US $ 276,8 milhões em 2023.

• Reembolso do médico da rede: US $ 187,4 milhões
• Taxas de consulta especializadas: US $ 59,2 milhões
• Incentivos baseados em desempenho: US $ 30,2 milhões

Despesas de processamento de reivindicações

Os custos de processamento de reivindicações para 2023 foram de US $ 62,3 milhões, representando 10,2% do total de gastos operacionais.

Componente de processamento de reivindicações	Custo anual ($)
Software e tecnologia	22,430,000
Pessoal	34,560,000
Sobrecarga administrativa	5,310,000

Custos de marketing e aquisição de clientes

As despesas de marketing em 2023 totalizaram US $ 41,7 milhões, com um custo de aquisição de clientes de US $ 453 por membro.

• Marketing Digital: US $ 18,2 milhões
• Publicidade tradicional: US $ 12,5 milhões
• Compensação da equipe de vendas: US $ 11 milhões

Conformidade regulatória e sobrecarga administrativa

Os custos administrativos e de conformidade atingiram US $ 87,6 milhões em 2023, constituindo 14,4% do total de despesas operacionais.

Categoria de conformidade	Custo anual ($)
Serviços legais e regulatórios	37,200,000
Auditoria e relatórios	22,800,000
Treinamento de conformidade	27,600,000

Alinhamento Healthcare, Inc. (ALHC) - Modelo de negócios: fluxos de receita

Medicare Advantage Plan Premiums

Para o ano fiscal de 2023, a Alinhamento Healthcare registrou um plano total do Medicare Advantage Plan Premium de US $ 2,26 bilhões. A empresa atende a aproximadamente 59.000 membros do Medicare Advantage em vários estados.

Ano	Medicare Advantage Premiums	Contagem de membros
2023	US $ 2,26 bilhões	59,000
2022	US $ 1,98 bilhão	52,000

Reembolsos ajustados ao risco

Em 2023, o alinhamento de saúde recebeu US $ 387,4 milhões em reembolsos ajustados ao risco do Medicare.

• Pagamento médio de ajuste de risco por membro: US $ 6.560
• Taxa de crescimento da receita de ajuste de risco: 14,3%

Contratos de atendimento baseados em valor

A empresa gerou US $ 214,6 milhões de contratos de atendimento baseados em valor em 2023, representando 9,5% da receita total.

Tipo de contrato	Receita	Porcentagem da receita total
Contratos de risco total	US $ 156,3 milhões	6.9%
Contratos de poupança compartilhados	US $ 58,3 milhões	2.6%

Licenciamento da plataforma de tecnologia

Receita de licenciamento de plataforma de tecnologia da Healthcare US $ 22,7 milhões em 2023.

Taxas de serviço de gerenciamento de cuidados

Taxas de serviço de gerenciamento de cuidados totalizaram US $ 45,2 milhões Para o ano fiscal de 2023.

Tipo de serviço	Receita
Serviços de coordenação de atendimento	US $ 28,6 milhões
Gerenciamento de doenças crônicas	US $ 16,6 milhões

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.