Humana Inc. (HUM): Modelo de negócios Canvas [Jan-2025 Atualizado]

No cenário dinâmico do seguro de saúde, a Humana Inc. é uma força transformadora, reimaginando como os americanos acordam e experimentam cobertura médica. Com um modelo de negócios estratégico que combina perfeitamente tecnologia inovadora, gerenciamento de terapia abrangente e soluções centradas no cliente, a Humana se posicionou como um ecossistema pioneiro de saúde que vai além dos paradigmas de seguros tradicionais. Ao alavancar plataformas digitais avançadas, extensas redes de fornecedores e programas de bem-estar personalizados, a empresa não está apenas vendendo seguros-criando experiências holísticas de saúde que capacitam os membros do Plano de Saúde Medicare, Medicaid e individuais a assumir o controle de seu bem-estar.

Humana Inc. (HUM) - Modelo de negócios: Parcerias -chave

Provedores de saúde e redes hospitalares

A Humana tem parcerias com 67.600 médicos de cuidados primários e 430.000 especialistas nos Estados Unidos a partir de 2023. A Companhia mantém colaborações estratégicas com aproximadamente 3.800 hospitais em todo o país.

Tipo de parceiro	Número de parceiros	Área de cobertura
Médicos de cuidados primários	67,600	Em todo o país
Médicos especializados	430,000	Em todo o país
Hospitais	3,800	Em todo o país

Medicare Advantage Plan Redes

A Humana opera em 49 estados com planos do Medicare Advantage, servindo 5,3 milhões de membros do Medicare Advantage a partir do quarto trimestre 2023.

Gerentes de benefícios de farmácia

A Humana colabora com os parceiros de Gerenciamento de Benefícios para Múltiplos Farmácias (PBM) para otimizar os serviços de medicamentos prescritos.

• Parceiro do PBM primário: Humana Pharmacy Solutions
• Cobertura de rede: mais de 68.000 farmácias de varejo
• Volume de prescrição: aproximadamente 300 milhões de prescrições processadas anualmente

Parceiros de solução de tecnologia e saúde digital

A Humana investe US $ 1,2 bilhão anualmente em tecnologia e inovações em saúde digital. As principais parcerias tecnológicas incluem:

Parceiro de tecnologia	Área de foco	Ano de parceria
Google Cloud	Análise de dados de assistência médica	2021
Teladoc Health	Serviços de telessaúde	2019
Maçã	Monitoramento da saúde digital	2020

Empresas de seguros e resseguros

A Humana mantém acordos de resseguros, cobrindo aproximadamente US $ 8,5 bilhões em transferência potencial de risco a partir de 2023.

Parceiro de resseguro	Valor da cobertura de risco	Tipo de cobertura
Swiss Re	US $ 3,2 bilhões	Reivindicações médicas
Munique re	US $ 2,7 bilhões	Vida e deficiência
Hannover re	US $ 2,6 bilhões	Saúde abrangente

Humana Inc. (HUM) - Modelo de negócios: Atividades -chave

Seguro de Saúde e Gerenciamento de Cobertura

A partir de 2024, Humana gerencia aproximadamente 4,9 milhões de membros do Medicare Advantage. A empresa processa um 185 milhões de reivindicações de saúde anualmente.

Segmento de seguro	Contagem de membros	Reivindicações anuais processadas
Vantagem do Medicare	4,9 milhões	185 milhões

Administração do Serviço Medicare e Medicaid

Humana opera em 44 estados para serviços do Medicare, com um Receita de US $ 22,4 bilhões de segmentos do governo em 2023.

• Participação de mercado do Medicare Advantage: 8%
• Membros de atendimento gerenciado do Medicaid: 1,2 milhão

Gerenciamento de benefícios de farmácia

Os serviços de farmácia da Humana gerenciam US $ 54,3 bilhões em custos de medicamentos prescritos anualmente.

Métricas de farmácia	Valor anual
Custos de medicamentos prescritos gerenciados	US $ 54,3 bilhões
Tamanho da rede de farmácias	67.000 farmácias

Desenvolvimento de Tecnologia da Saúde Digital

Humana investiu US $ 486 milhões em tecnologia e inovação Em 2023, foco em plataformas de telessaúde e monitoramento remoto.

• Plataformas de saúde digital: 3 plataformas principais
• Interações de telessaúde: 2,7 milhões de consultas anuais

Programas de coordenação e bem -estar de cuidados

Humana gerencia Mais de 500 programas de bem -estar e cuidados preventivos, servindo aproximadamente 5,3 milhões de participantes.

Métricas do Programa de Bem -Estar	Contagem/participantes
Total de programas de bem -estar	500+
Participantes do programa	5,3 milhões

Humana Inc. (HUM) - Modelo de negócios: Recursos -chave

Extensa rede de prestadores de serviços de saúde

A partir de 2024, a Humana mantém uma rede de aproximadamente 455.000 prestadores de serviços de saúde nos Estados Unidos. A rede inclui:

Tipo de provedor	Número de provedores
Médicos de cuidados primários	87,300
Especialistas	193,500
Hospitais	4,800
Farmácias	169,400

Recursos avançados de análise de dados

A infraestrutura de análise de dados da Humana inclui:

• Mais de 20 petabytes de dados de saúde processados ​​anualmente
• Algoritmos de aprendizado de máquina analisando padrões de saúde do paciente
• Plataformas de modelagem preditiva, cobrindo 14 milhões de registros individuais de pacientes

Plataformas de saúde digital e infraestrutura de tecnologia

Detalhes de investimento em tecnologia:

Categoria de tecnologia	Valor do investimento (2024)
Plataformas de saúde digital	US $ 342 milhões
Infraestrutura de segurança cibernética	US $ 127 milhões
Tecnologias de telessaúde	US $ 89 milhões

Capital financeiro forte e reservas

Recursos Financeiros a partir do quarto trimestre 2023:

• Total de ativos: US $ 75,3 bilhões
• Caixa e equivalentes em dinheiro: US $ 4,2 bilhões
• Total dos acionistas do patrimônio: US $ 18,6 bilhões

Equipes experientes de gerenciamento de saúde

Métrica de Gerenciamento	Estatística
Experiência média de saúde executiva	22,4 anos
Liderança sênior com diplomas avançados	87%
Promoções internas para funções de liderança	63%

Humana Inc. (HUM) - Modelo de Negócios: Proposições de Valor

Opções abrangentes de cobertura de saúde

A Humana oferece cobertura de assistência médica com receita total de US $ 92,1 bilhões em 2022. Os planos do Medicare Advantage cobriam 5,3 milhões de membros a partir do quarto trimestre de 2022.

Tipo de cobertura	Contagem de membros	Premium anual
Vantagem do Medicare	5,3 milhões	US $ 6.780 por membro
Seguro comercial	1,2 milhão	US $ 5.400 por membro
Medicaid	1,8 milhão	US $ 4.200 por membro

Soluções personalizadas do Medicare e Medicaid

A Humana fornece soluções especializadas do Medicare com 87% da classificação de satisfação do cliente.

• Planos de suplementos do Medicare
• Cobertura de prescrição do Medicare Parte D
• Planos de necessidades especiais do Medicare Advantage

Serviços de gerenciamento de cuidados integrados

O gerenciamento de atendimento integrado gera US $ 3,2 bilhões em receita anual com eficácia de coordenação de 92% de atendimento.

Capacidades de saúde digital e telemedicina

A plataforma de saúde digital suporta 2,4 milhões de consultas virtuais em 2022, representando um crescimento de 18% ano a ano.

Métrica de telemedicina	2022 dados
Consultas virtuais	2,4 milhões
Usuários da plataforma de saúde digital	1,6 milhão

Programas preventivos de bem -estar e gerenciamento de doenças crônicas

Os programas crônicos de gerenciamento de doenças atendem a 3,1 milhões de membros com US $ 1,5 bilhão investidos anualmente.

• Programa de Gerenciamento de Diabetes
• Prevenção de doenças cardíacas
• Serviços de gerenciamento de peso

Humana Inc. (HUM) - Modelo de Negócios: Relacionamentos do Cliente

Portais de membros on -line e aplicativos móveis

Em 2024, as plataformas digitais da Humana atendem a aproximadamente 5,3 milhões de usuários digitais ativos. O aplicativo Myhumana Mobile foi baixado mais de 2,1 milhões de vezes, com uma classificação de usuário de 4,6/5.

Métrica da plataforma digital	2024 Estatísticas
Usuários digitais ativos	5,3 milhões
Downloads de aplicativos móveis	2,1 milhões
Classificação de usuário de aplicativo móvel	4.6/5

Centros de suporte ao cliente 24/7

Humana opera 17 centros de suporte ao cliente Em todo o país, lidando com aproximadamente 3,8 milhões de interações com os clientes mensalmente.

• Tempo médio de resolução de chamadas: 8,2 minutos
• Taxa de satisfação do cliente: 89%
• Suporte multilíngue disponível em 6 idiomas

Serviços personalizados de treinamento em saúde

Em 2024, a Humana fornece treinamento de saúde personalizado a 672.000 membros, com uma duração média de engajamento de 6,4 meses por participante.

Métrica de treinamento em saúde	2024 dados
Membros recebendo treinamento	672,000
Duração média do treinamento	6,4 meses

Avaliações regulares de risco à saúde

A Humana realiza avaliações de risco à saúde de 1,9 milhão de membros anualmente, com uma taxa de conclusão de 73%.

• Taxa de conclusão da avaliação: 73%
• Tempo médio de avaliação: 22 minutos
• Opções de avaliação digital: 64% das avaliações

Programas de educação em saúde comunitária

A Humana apoia 287 iniciativas de educação em saúde comunitária em 42 estados, atingindo aproximadamente 1,1 milhão de participantes em 2024.

Métrica do Programa Comunitário	2024 Estatísticas
Iniciativas comunitárias	287
Estados cobertos	42
Participantes do programa	1,1 milhão

Humana Inc. (HUM) - Modelo de Negócios: Canais

Plataformas digitais e aplicativos móveis

Os canais digitais da Humana incluem:

• Myhumana Mobile App com 2,3 milhões de usuários ativos a partir do quarto trimestre 2023
• Portal de pacientes on -line com 4,7 milhões de usuários registrados
• Serviços de telessaúde que suportam 1,2 milhão de consultas virtuais anualmente

Plataforma digital	Métricas de usuário	Engajamento anual
Myhumana Mobile App	2,3 milhões de usuários ativos	8,6 milhões de interações totais
Portal de pacientes on -line	4,7 milhões de usuários registrados	15,3 milhões de logins anuais

Representantes de vendas diretas

A Humana mantém uma força de vendas direta de 3.742 representantes de seguros dedicados a partir de 2024.

• Produtividade representativa de vendas médias: receita anual de US $ 1,2 milhão
• Cobertura geográfica em 50 estados
• Equipes especializadas para mercados do Medicare, Comercial e Individuais

Corretores de seguros e agentes

A rede de corretoras da Humana inclui:

• 17.500 agentes de seguros independentes contratados
• Estrutura de comissão variando de 3-8% por política
• Receita anual gerada por corretor: US $ 2,4 bilhões

Parcerias do grupo de empregadores

Categoria de parceria	Número de parcerias	Vidas cobertas
Grandes empregadores (mais de 1000 funcionários)	423 parcerias	1,6 milhão de vidas cobertas
Empregadores de tamanho médio (100-999 funcionários)	1.872 parcerias	2,3 milhões de vidas cobertas

Sites de marketing on -line e comparação

Investimentos de canais de marketing digital:

• Orçamento anual de marketing digital: US $ 87,6 milhões
• Parcerias com 12 principais plataformas de comparação de seguros
• Gastes de publicidade digital direcionados: US $ 42,3 milhões

Canal online	Alcance anual	Taxa de conversão
Google AdWords	3,2 milhões de impressões	4.7%
Sites de comparação de seguros	2,8 milhões de visitantes únicos	3.9%

Humana Inc. (HUM) - Modelo de negócios: segmentos de clientes

Indivíduos elegíveis do Medicare

A partir de 2023, a Humana atende a aproximadamente 5,3 milhões de membros do Medicare Advantage. O segmento Medicare da empresa representa um segmento crítico de clientes com a seguinte quebra:

Métrica do segmento do Medicare	Dados quantitativos
Membros do Total Medicare Advantage	5,3 milhões
Medicare Suplement Insurance Inscreva -se	1,2 milhão
MEDICARE PARTE D MEMBROS DE PLOM DE MEDORES DE PRESCRIÇÃO	3,8 milhões

Destinatários do Medicaid

O segmento Medicaid da Humana se concentra nos serviços de saúde baseados no estado:

• Total de membros do Medicaid: 1,1 milhão
• Operacional em 18 estados
• Medicaid gerenciado vidas: 756.000

Consumidores de saúde seniores

A Humana tem como alvo especificamente idosos com soluções especializadas em saúde:

Métricas sênior de saúde	Dados quantitativos
65+ faixa etária coberta	4,9 milhões de indivíduos
Planos de assistência médica específicos para sênior	42 configurações de plano diferentes

Membros do plano de saúde do grupo de empregadores

O segmento comercial da Humana inclui soluções abrangentes de saúde do empregador:

• Membros do grupo total de empregadores: 2,6 milhões
• Participação de mercado em pequenos grupos: 7,2%
• Cobertura de mercado de grandes grupos: 1,4 milhão de membros

Buscadores de seguro de saúde individuais

Detalhes do segmento de mercado individuais:

Métricas de mercado individuais	Dados quantitativos
Total de membros do mercado individual	853,000
Participantes do mercado da ACA	412,000
INSCRIÇÕES DE SEGURO DE SAÚDE DO GRUPO	441,000

Humana Inc. (HUM) - Modelo de negócios: estrutura de custos

Reembolsos de Serviço de Saúde

Em 2023, os custos totais de reembolso dos serviços de saúde da Humana foram de aproximadamente US $ 61,4 bilhões. A quebra das despesas de reembolso inclui:

Categoria de reembolso	Custo ($)
Reclamações do Medicare Advantage	42,3 bilhões
Reivindicações de seguro comercial	12,7 bilhões
Reembolsos do Medicaid	6,4 bilhões

Investimentos de tecnologia e infraestrutura

Os investimentos em tecnologia e infraestrutura da Humana para 2023 totalizaram US $ 1,2 bilhão, com alocações específicas:

• Plataformas de saúde digital: US $ 425 milhões
• Infraestrutura de computação em nuvem: US $ 310 milhões
• Sistemas de segurança cibernética: US $ 215 milhões
• Sistemas de análise de dados: US $ 250 milhões

Compensação e benefícios dos funcionários

As despesas totais relacionadas aos funcionários em 2023 foram de US $ 8,6 bilhões, estruturados da seguinte forma:

Categoria de compensação	Custo ($)
Salários da base	5,4 bilhões
Benefícios de saúde	1,7 bilhão
Contribuições de aposentadoria	680 milhões
Bônus de desempenho	820 milhões

Despesas de marketing e aquisição de clientes

As despesas de marketing para 2023 totalizaram US $ 1,5 bilhão, distribuídas entre os canais:

• Marketing Digital: US $ 520 milhões
• Publicidade tradicional: US $ 410 milhões
• Comissões de vendas diretas: US $ 370 milhões
• Programas de retenção de clientes: US $ 200 milhões

Conformidade regulatória e custos administrativos

As despesas administrativas e de conformidade em 2023 foram de US $ 2,3 bilhões, com a seguinte alocação:

Categoria de conformidade	Custo ($)
Conformidade legal e regulatória	850 milhões
Sobrecarga administrativa	740 milhões
Auditoria e gerenciamento de riscos	410 milhões
Relatórios e documentação	300 milhões

Humana Inc. (HUM) - Modelo de negócios: fluxos de receita

Medicare Advantage Plan Premiums

Para o ano fiscal de 2023, o segmento Medicare Advantage da Humana gerou US $ 23,4 bilhões em receitas premium. A empresa registrou 5,3 milhões de membros do Medicare Advantage em 31 de dezembro de 2023.

Ano	Medicare Advantage Premiums	Total de membros
2023	US $ 23,4 bilhões	5,3 milhões

Contratos de Serviço Medicaid

O segmento Medicaid da Humana gerou US $ 5,2 bilhões em receita para 2023, atendendo a aproximadamente 1,1 milhão de membros do Medicaid em vários estados.

Taxas de gerenciamento de benefícios de farmácia

A receita de serviços de farmácia para 2023 atingiu US $ 16,8 bilhões, com Taxas de gerenciamento de benefícios de farmácia (PBM) contribuindo significativamente para esse total.

Categoria de serviço PBM	Receita (2023)
Processamento de prescrição	US $ 4,6 bilhões
Gerenciamento de rede	US $ 3,2 bilhões

Receitas de Serviço de Tecnologia da Saúde

Os serviços de tecnologia de saúde da Humana geraram US $ 780 milhões em receita para 2023, com foco em plataformas de saúde digital e tecnologias de coordenação de cuidados.

• Serviços de telessaúde: US $ 245 milhões
• Software de gerenciamento de cuidados: US $ 335 milhões
• Plataformas de saúde digital: US $ 200 milhões

Vendas de produtos de seguro suplementar

As receitas de produtos de seguro suplementar totalizaram US $ 2,1 bilhões em 2023, incluindo ofertas de suplementos do Medicare e ofertas de seguros odontológicos.

Produto suplementar	Receita (2023)
Suplemento do Medicare	US $ 1,4 bilhão
Seguro odontológico	US $ 420 milhões
Seguro de visão	US $ 280 milhões

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.