Elevance Health Inc. (ELV): Modelo de Negócios Canvas [Jan-2025 Atualizado]

No cenário dinâmico do seguro de saúde, a Elevance Health Inc. (ELV) surge como uma potência transformadora, redefinindo como os americanos acessam e experimentam cobertura médica. Esta empresa inovadora criou meticulosamente um modelo de negócios que vai além do seguro tradicional, integrando tecnologias digitais de ponta, programas abrangentes de bem-estar e soluções de saúde personalizadas. Ao aproveitar estrategicamente uma extensa rede de parcerias e análise de dados avançada, a Healance Health não está apenas vendendo seguros-eles estão revolucionando todo o ecossistema de saúde, tornando os cuidados médicos abrangentes, econômicos e tecnologicamente avançados acessíveis a milhões em diversos segmentos de clientes.

Elevance Health Inc. (ELV) - Modelo de Negócios: Principais Parcerias

Provedores de saúde e hospitais em todo o país

A Elevance Health mantém parcerias com aproximadamente 106.000 médicos de cuidados primários e 510.000 médicos de atendimento especializado a partir de 2023. A Companhia possui relações contratuais com mais de 4.700 hospitais em todo o país.

Tipo de parceria	Número de provedores	Área de cobertura
Médicos de cuidados primários	106,000	Em todo o país
Médicos de atendimento especializado	510,000	Em todo o país
Hospitais	4,700	Em todo o país

Gerentes de benefícios farmacêuticos (PBMS)

A Elevance Health possui a Ingeniorx, um dos maiores PBMs dos Estados Unidos, que atende a aproximadamente 45 milhões de membros.

• Participação de mercado da PBM: aproximadamente 7,5% do mercado total de PBM
• Reivindicações de prescrição processadas anualmente: mais de 1,2 bilhão

Parceiros de solução de tecnologia e saúde digital

A Elevance Health colabora com vários parceiros de tecnologia para aprimorar as soluções de saúde digital.

Categoria de parceiro	Número de parcerias	Área de foco
Plataformas de telessaúde	12	Deliveria de assistência médica remota
Soluções de saúde da IA	8	Análise preditiva
Monitoramento da saúde digital	15	Engajamento do paciente

Programas de saúde do governo

A Saúde da Elevance participa de vários programas de saúde do governo em diferentes estados.

• Contratos do Medicaid: ativo em 19 estados
• Membros do Medicare Advantage: mais de 2,3 milhões
• Membros do programa total do governo: aproximadamente 6,5 milhões

Empresas de seguros e resseguros

A Elevance Health mantém parcerias estratégicas com várias entidades de seguros e resseguros.

Tipo de parceria	Número de parceiros	Cobertura de mitigação de risco
Empresas de resseguro	7	Cobertura total de US $ 5,2 bilhões
Parceiros de seguro regional	23	Compartilhamento de riscos em todo o país

Elevance Health Inc. (ELV) - Modelo de Negócios: Atividades -chave

Seguro de Saúde e Gerenciamento de Cobertura Médica

A Elevance Health gerencia a cobertura do seguro de saúde por aproximadamente 47,5 milhões de membros em vários segmentos a partir de 2023. A empresa opera em 14 estados com planos abrangentes de cobertura médica.

Segmento de cobertura	Número de membros
Seguro comercial	28,3 milhões
Medicare	8,9 milhões
Medicaid	10,3 milhões

Processamento e administração de reivindicações

Elevança processos de saúde de aproximadamente 250 milhões de reclamações anualmente com uma taxa de eficiência de processamento digital de 92%. O sistema de administração de reivindicações da empresa lida:

• Reivindicações médicas
• Reivindicações de farmácia
• Reivindicações odontológicas
• Reivindicações de visão

Desenvolvimento de rede de assistência médica

A empresa mantém uma rede de 106.000 prestadores de serviços de saúde e 6.200 hospitais em seus estados operacionais. A composição da rede inclui:

Tipo de provedor	Número
Médicos de cuidados primários	48,500
Médicos especializados	57,500

Inovação em tecnologia da saúde digital

A Elevance Health investiu US $ 782 milhões em tecnologias de saúde digital em 2023. Os principais investimentos tecnológicos incluem:

• Plataformas de telemedicina
• Sistemas de monitoramento de saúde orientados pela IA
• Aplicativos de saúde móvel
• Integração eletrônica de registro de saúde

Design do programa de bem -estar e cuidados preventivos

A empresa implementa programas de bem -estar para 35,6 milhões de membros, com um investimento anual de US $ 425 milhões em iniciativas de atendimento preventivo.

Categoria de programa	Participantes anuais
Gerenciamento de doenças crônicas	12,3 milhões
Apoio à saúde mental	8,7 milhões
Programas de fitness e nutrição	14,6 milhões

Elevance Health Inc. (ELV) - Modelo de negócios: Recursos -chave

Extensa rede de prestadores de serviços de saúde

A partir de 2024, a Healance Health mantém uma rede abrangente de:

Tipo de provedor	Número total
Hospitais	67,000+
Médicos	106,000+
Farmácias	64,000+

Plataformas avançadas de saúde digital

A infraestrutura digital inclui:

• Plataformas proprietárias de telessaúde
• Sistemas de monitoramento de saúde movidos a IA
• Aplicativos de saúde móvel

Métrica da plataforma digital	2024 Estatísticas
Interações anuais de saúde digital	42 milhões+
Usuários de aplicativos móveis	8,3 milhões

Recursos de análise de dados em larga escala

Recursos de análise de dados:

• Data Warehouse de saúde proprietária
• Algoritmos de aprendizado de máquina
• Sistemas de modelagem de saúde preditivos

Métrica de análise de dados	2024 Capacidades
Registros de saúde processados	290 milhões+
Capacidade anual de processamento de dados	1.2 Petabytes

Forte infraestrutura financeira

Recursos Financeiros a partir de 2024:

Métrica financeira	Quantia
Receita total	US $ 142,5 bilhões
Fluxo de caixa operacional	US $ 8,3 bilhões
Total de ativos	US $ 186,7 bilhões

Equipes experientes de gerenciamento de saúde

Métrica de Gerenciamento	2024 Estatística
Total de funcionários	116,000+
Experiência de gerenciamento médio	17,5 anos

Elevance Health Inc. (ELV) - Modelo de Negócios: Proposições de Valor

Cobertura abrangente de seguro de saúde

A partir do quarto trimestre de 2023, a Elevance Health Inc. fornece cobertura de seguro de saúde para 47,8 milhões de membros no Medicare e nos segmentos do Medicare e do Medicaid. Os prêmios totais de seguro de saúde da empresa atingiram US $ 117,4 bilhões em receita anual para 2023.

Segmento de seguro	Número de membros	Quota de mercado
Comercial	24,3 milhões	16.2%
Medicare	12,5 milhões	11.7%
Medicaid	11 milhões	9.5%

Soluções de saúde personalizadas

A Elevance Health investe US $ 782 milhões anualmente em plataformas personalizadas de tecnologia de saúde e análise de dados.

• Avaliação preditiva de risco para a saúde orientada pela IA
• Programas de gerenciamento de cuidados personalizados
• Recomendações de tratamento individualizadas

Opções de serviço digital e de telessaúde

Os serviços de saúde digital representam 22,4% do total de interações dos pacientes, com 8,3 milhões de consultas de telessaúde realizadas em 2023.

Serviço de Saúde Digital	Utilização anual
Consultas do médico virtual	5,6 milhões
Telessaúde de saúde mental	1,7 milhão
Gerenciamento de doenças crônicas	1 milhão

Gerenciamento de assistência médica econômica

A Saúde da Elevance reduz os custos de saúde em 14,6% por meio de estratégias de gerenciamento de cuidados avançados, economizando aproximadamente US $ 3,2 bilhões para os membros em 2023.

Programas integrados de bem -estar e cuidados preventivos

A empresa opera 672 centros de bem -estar e investe US $ 456 milhões em iniciativas de atendimento preventivo, cobrindo 35,6% de sua base total de membros.

• Exibições anuais de saúde
• Programas de prevenção de doenças crônicas
• Intervenções de gerenciamento de estilo de vida

Elevance Health Inc. (ELV) - Modelo de Negócios: Relacionamentos do Cliente

Portais de membros online

A partir de 2024, a Healance Health mantém um portal de membros on -line com as seguintes métricas -chave:

Métrica portal	Dados específicos
Total de membros digitais	4,6 milhões de usuários ativos
Taxa mensal de login do portal	62% dos membros registrados
Transações de autoatendimento	3,2 milhões de transações digitais mensais

Centros de Suporte ao Atendimento ao Cliente

A Saúde da Elevance opera a infraestrutura de suporte ao cliente com estas especificações:

• Centros de suporte ao cliente 24/7
• Tempo médio de resposta do call center: 2,7 minutos
• Volume anual de suporte ao cliente: 12,4 milhões de interações
• Suporte multicanal, incluindo telefone, e-mail e bate-papo

Plataformas de engajamento de aplicativos móveis

Métricas de engajamento de aplicativos móveis para 2024:

Métrica de aplicativo móvel	Dados específicos
Downloads de aplicativos móveis totais	3,8 milhões de downloads
Usuários ativos mensais	2,1 milhões de usuários
Duração média da sessão do aplicativo	7,4 minutos por sessão

Ferramentas de gestão de saúde personalizadas

Recursos personalizados da plataforma de gerenciamento de saúde:

• Avaliações de risco à saúde orientadas pela IA
• Recomendações personalizadas de bem -estar
• Programas de gerenciamento de condições crônicas
• Serviços de treinamento em saúde digital

Atualizações regulares de comunicação e saúde

Métricas de desempenho do canal de comunicação:

Canal de comunicação	Engajamento mensal
E -mail boletins de saúde	2,9 milhões de assinantes
Alertas de saúde do SMS	1,7 milhão de destinatários ativos
Recomendações de saúde personalizadas	3,4 milhões de comunicações direcionadas

Elevance Health Inc. (ELV) - Modelo de Negócios: Canais

Plataformas digitais e aplicativos móveis

Elevance Health opera o Aplicativo móvel de saúde de Sydney, que atende a mais de 12 milhões de membros em 2023. A plataforma digital processa aproximadamente 3,5 milhões de interações digitais mensais para serviços de saúde.

Canal digital	Usuários ativos mensais	Funções -chave
Sydney Health App	12 milhões	Revisão de reivindicações, pesquisa de provedores, cartão de identificação digital
Portal da Web	8,2 milhões	Gerenciamento de benefícios, inscrição

Corretores de seguros e agentes

Elevance Health mantém uma rede de 3.700 corretores de seguros licenciados Em 14 estados, gerando aproximadamente US $ 2,3 bilhões em receita premium anual por meio de canais de vendas indiretos.

Equipes de vendas diretas

A empresa emprega 1.200 representantes de vendas dedicados Segmentando mercados individuais e em grupo, com um volume médio de vendas anuais de US $ 187 milhões por equipe de vendas.

Categoria de vendas	Tamanho da equipe	Receita anual
Mercado individual	650 representantes	US $ 1,1 bilhão
Mercado de grupo	550 representantes	US $ 1,2 bilhão

Programas de inscrição em grupo de empregadores

Elevance Saúde serve Mais de 46.000 grupos de empregadores, cobrindo aproximadamente 16,5 milhões de membros por meio de planos de saúde corporativos.

• Segmento de pequenas empresas: 28.000 empregadores
• Segmento do mercado intermediário: 12.500 empregadores
• Grande segmento da empresa: 5.500 empregadores

Portais de marketing on -line e web

A empresa investe US $ 124 milhões anualmente em marketing digital, gerando 2,6 milhões de conversões online nas linhas de produtos da saúde.

Canal de marketing	Investimento anual	Taxa de conversão
Publicidade digital paga	US $ 78 milhões	1,4 milhão de conversões
Marketing da Web orgânico	US $ 46 milhões	1,2 milhão de conversões

Elevance Health Inc. (ELV) - Modelo de negócios: segmentos de clientes

Consumidores de seguro de saúde individuais

A partir de 2023, a Elevance Health atende a aproximadamente 47,8 milhões de consumidores individuais de seguro de saúde em vários estados. A quebra da base de clientes inclui:

Faixa etária	Número de consumidores	Percentagem
18-34 anos	12,3 milhões	25.7%
35-54 anos	18,5 milhões	38.7%
55 anos ou mais	17 milhões	35.6%

Grupos corporativos e de empregadores

A Elevance Health oferece cobertura de seguro de saúde para 16,2 milhões de funcionários em vários setores.

Setor da indústria	Número de funcionários cobertos
Tecnologia	3,4 milhões
Fabricação	2,9 milhões
Assistência médica	2,7 milhões
Varejo	2,5 milhões
Outros setores	4,7 milhões

Beneficiários do Medicare e Medicaid

Beneficiários totais do Medicare e Medicaid atendidos: 14,6 milhões

• Medicare Advantage Instrollees: 8,3 milhões
• Medicaid Gerenciado Cuidado inscrito: 6,3 milhões

Pequenas a médias empresas

A Saúde da Elevance cobre 1,2 milhão de empresas pequenas e médias nos Estados Unidos.

Tamanho comercial	Número de negócios	Funcionários médios por empresa
Pequenas empresas (10-50 funcionários)	780,000	25
Empresas médias (51-500 funcionários)	420,000	150

Profissionais autônomos

A Saúde Health atende a 2,1 milhões de profissionais autônomos em vários setores.

• Freelancers: 1,2 milhão
• Empreiteiros independentes: 580.000
• Proprietários de pequenas empresas: 320.000

Elevance Health Inc. (ELV) - Modelo de Negócios: Estrutura de Custo

Manutenção de rede de provedores de saúde

Em 2023, a Elevance Health Inc. relatou despesas de manutenção de rede de US $ 4,2 bilhões. A quebra de custo inclui:

Categoria de despesa	Valor (US $ milhões)
Negociações de contrato de provedores	1,350
Credenciamento de rede	620
Gerenciamento de desempenho do provedor	780

Despesas de processamento de reivindicações

Os custos de processamento de reivindicações para a saúde da elevação em 2023 totalizaram US $ 2,8 bilhões.

• Infraestrutura de processamento de reivindicações digitais: US $ 890 milhões
• Revisão de reivindicações manuais: US $ 650 milhões
• Sistemas de detecção de fraude de reivindicações: US $ 420 milhões

Tecnologia e infraestrutura digital

O investimento em tecnologia para 2023 atingiu US $ 1,6 bilhão.

Segmento de tecnologia	Despesas (US $ milhões)
Computação em nuvem	520
Segurança cibernética	340
Plataformas de saúde digital	450

Custos administrativos e operacionais

As despesas administrativas de 2023 foram de US $ 3,5 bilhões.

• Organização corporativa: US $ 1,2 bilhão
• Recursos Humanos: US $ 620 milhões
• Relatórios de conformidade e regulamentação: US $ 540 milhões

Despesas de marketing e aquisição de clientes

As despesas de marketing para 2023 totalizaram US $ 1,1 bilhão.

Canal de marketing	Gastos (US $ milhões)
Marketing digital	420
Publicidade tradicional	350
Custos representativos de vendas	330

Elevance Health Inc. (ELV) - Modelo de negócios: fluxos de receita

Prêmios de seguro de saúde

Receita total de prêmios de seguro de saúde para elevance Health Inc. em 2022: US $ 117,7 bilhões

Segmento	Receita Premium (2022)
Seguro comercial	US $ 48,3 bilhões
Medicare	US $ 35,6 bilhões
Medicaid	US $ 33,8 bilhões

Reembolsos do Programa de Saúde do Governo

Reembolsos totais de saúde do governo em 2022: US $ 69,4 bilhões

• Reembolsos do Medicare Advantage: US $ 42,1 bilhões
• Reembolsos de cuidados gerenciados do Medicaid: US $ 27,3 bilhões

Taxas do programa de bem -estar

Receita do Programa de Bem -Estar em 2022: US $ 1,2 bilhão

Cobranças de serviço de saúde digital

Receita do Serviço de Saúde Digital em 2022: US $ 780 milhões

Tipo de serviço digital	Receita
Serviços de telessaúde	US $ 420 milhões
Monitoramento remoto de pacientes	US $ 210 milhões
Gerenciamento de atendimento digital	US $ 150 milhões

Receitas de gerenciamento de benefícios de farmácia

Receita de gerenciamento de benefícios de farmácia em 2022: US $ 24,6 bilhões

• Processamento de reivindicações de medicamentos prescritos: US $ 18,3 bilhões
• Gerenciamento de rede de farmácias: US $ 4,2 bilhões
• Serviços de preços e descontos de drogas: US $ 2,1 bilhões

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.