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Here are 1-3 brief analogies to describe Elevance Health (ELV):

• State Farm for health insurance.
• JPMorgan Chase for health benefits and services.

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• Health Benefit Plans: Provides a comprehensive range of health insurance plans for employer groups, individuals, and government-sponsored programs like Medicare and Medicaid.
• Pharmacy Benefits Management (CarelonRx): Manages prescription drug benefits, including formulary management, drug utilization review, and claims processing for health plan members.
• Healthcare Services and Solutions (Carelon): Offers care delivery and management services such as behavioral health, complex care management, home-based care, and advanced analytics for healthcare providers and payers.

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Elevance Health (ELV) operates primarily as a health benefits company, serving a broad spectrum of individuals through various channels. Given the diversified nature of its customer base rather than reliance on a few major corporate clients, its customers can be best understood through the following categories:

1. Employer Groups (Commercial Market): Elevance Health provides health insurance plans to a vast number of large, medium, and small businesses across the United States. These businesses choose Elevance Health plans to offer health benefits to their employees. While these are companies, Elevance Health's commercial business is highly diversified, with no single employer group representing a major identifiable customer that would typically be disclosed.

2. Government-Sponsored Programs: This significant segment involves partnerships with government entities to administer health benefits for specific populations. Key programs include:

   • Medicaid: Elevance Health contracts with state governments to provide healthcare services for low-income individuals and families. The states are the primary contracting customers in this instance.
   • Medicare Advantage: Elevance Health offers private health plans to eligible seniors and other beneficiaries under the federal Medicare program. While individuals enroll in these plans, the Centers for Medicare & Medicaid Services (CMS) is the overarching federal entity that contracts with private insurers like Elevance.
   • Federal Employee Program (FEP): Administering health benefits for federal employees, retirees, and their dependents in partnership with the Office of Personnel Management (OPM).

3. Direct Individual & Family Purchasers: Elevance Health also offers health insurance plans directly to individuals and families who purchase coverage outside of an employer or government program. These plans are available through public health insurance marketplaces (exchanges) established under the Affordable Care Act, as well as directly from Elevance Health (off-exchange).

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• CVS Health (CVS)
• Walgreens Boots Alliance (WBA)
• Walmart Inc. (WMT)
• Alphabet Inc. (GOOGL)
• Palantir Technologies Inc. (PLTR)

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Gail K. Boudreaux, President & CEO

Ms. Boudreaux has over three decades of deep expertise in the healthcare industry, serving as President and Chief Executive Officer of Elevance Health since November 2017. Prior to joining Elevance Health (formerly Anthem, Inc.), she was the Chief Executive Officer of UnitedHealthcare, the largest business division of UnitedHealth Group, where she was responsible for approximately $120 billion in revenue and managed over 60,000 employees serving 45 million consumers. Earlier in her career, she served as Executive Vice President of Health Care Services Corporation and President of Blue Cross/Blue Shield of Illinois. In 2015, Ms. Boudreaux founded and became CEO of GKB Global Health, LLC, a healthcare strategy and business advisory firm. She has also served on the boards of directors for other public companies such as Target, Novavax, and Xcel Energy.

Mark Kaye, Executive Vice President & CFO

Mr. Kaye was named Executive Vice President and Chief Financial Officer of Elevance Health, with full responsibility for the role commencing November 1, 2023. He joined Elevance Health from Moody's Corporation, where he served as Chief Financial Officer, overseeing all global finance activities. Before his time at Moody's, Mr. Kaye held various leadership roles in strategic finance, financial planning and analysis, and large-scale project management at companies including MassMutual Life Insurance Company and Voya Financial.

Peter D. Haytaian, Executive Vice President; President of Carelon and CarelonRx

Mr. Haytaian serves as Executive Vice President of Elevance Health and President for Carelon and CarelonRx, where he is responsible for the strategic direction, performance, and growth of Carelon's diversified assets and services, including pharmacy, behavioral health, complex and chronic care, and advanced analytics. He previously held roles at Elevance Health as Executive Vice President and President of Commercial Health Benefits, and Executive Vice President and President of Government Health Benefits. His prior experience also includes serving as Chief Executive Officer of the Northeastern Region at Amerigroup Corp. and President and Chief Executive Officer of Amerigroup New Jersey Inc.

Felicia F. Norwood, Executive Vice President & President of Government Health Benefits

Ms. Norwood holds the position of Executive Vice President and President of Government Health Benefits at Elevance Health. In this role, she is responsible for the strategic direction and all operations related to the company's Medicaid, Medicare, and federal government solutions businesses.

Morgan Kendrick, Executive Vice President & President of Commercial and Specialty Health Benefits

Mr. Kendrick has been with Elevance Health (and its affiliated companies) since 1995 and has served as President of the Commercial and Specialty Business Division since October 2021.

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1. Rising Healthcare Costs and Medical Expenses: Elevance Health faces significant challenges from increasing medical expenses and rising healthcare utilization, particularly within its Medicare Advantage and Medicaid plans. This trend directly impacts the company's margins and overall profitability. The company has indicated that it expects a decline in Medicaid margins as state payment rates frequently do not adequately cover members' medical costs.
2. Regulatory Changes and Scrutiny: The highly regulated healthcare industry exposes Elevance Health to substantial risks from changes in federal and state regulations. Modifications to policies related to Medicare Advantage, Medicaid, and the Affordable Care Act (ACA) can significantly affect the company's operations, revenue, and profitability. Specific concerns include potential increased oversight and Senate hearings concerning Medicare Advantage, stricter reporting requirements, and the anticipated expiration of enhanced premium tax credits for ACA plans. Furthermore, ongoing investigations into potential securities law violations underscore the company's exposure to regulatory and compliance risks.
3. Medicaid Membership Fluctuations and Redeterminations: The reduction in the total number of Medicaid members, largely due to state-initiated redeterminations of eligibility, is directly impacting Elevance Health's membership numbers and financial margins. This trend has also led to a sicker pool of remaining Medicaid members, which in turn drives up healthcare costs for the company. There is also a potential for a notable contraction in the ACA marketplace if enhanced subsidies expire, further contributing to membership-related risks.

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• Increased regulatory scrutiny and potential reform of Pharmacy Benefit Managers (PBMs). Elevance Health operates CarelonRx, a significant PBM. There is substantial bipartisan legislative and regulatory momentum in the U.S. to increase transparency, regulate PBM practices, and potentially delink PBM compensation from drug prices, which could directly impact a substantial revenue and profit stream for ELV.
• Expansion of non-traditional players (tech and retail giants) into healthcare delivery and pharmacy services. Companies like Amazon (e.g., One Medical, RxPass), Walmart (e.g., health clinics), and CVS Health (e.g., Signify Health, Oak Street Health) are aggressively expanding their footprint across primary care, urgent care, pharmacy, and home health. While not directly replacing insurance plans, these players aim to control more aspects of the healthcare value chain, potentially disintermediating traditional insurers from parts of the care delivery process, influencing member choice, and creating new, integrated models that could bypass or reduce the role of traditional insurers.

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Elevance Health (symbol: ELV) operates within several significant addressable markets in the United States, primarily focusing on health insurance, pharmacy benefit management, and care management solutions.

For its health insurance products and services, which include commercial, Medicare, Medicaid, and individual plans, the U.S. health insurance market demonstrates substantial size. The U.S. health insurance market was valued at approximately USD 1.23 trillion in 2024 and is projected to reach USD 1.77 trillion by 2030, growing at a Compound Annual Growth Rate (CAGR) of 6.98%. Other estimates place the U.S. health insurance market size at USD 453 billion in 2024, expected to reach USD 639 billion by 2033 with a CAGR of 3.7% from 2025-2033. Another report indicates the U.S. health insurance market was valued at USD 613.0 billion in 2024 and is expected to increase to USD 1161.7 billion by 2032, advancing at a CAGR of 8.5% during 2025–2032. The broader U.S. managed care market, encompassing Medicare, Medicaid, and private health insurance, is forecasted to reach US$4.37 trillion in 2028, with a CAGR of 6.09% from 2024 to 2028. Elevance Health is a leading player in this sector, holding an exclusive license for the Blue Cross Blue Shield brand in 14 states and insuring approximately one out of every three people in these licensed states.

In the realm of pharmacy benefit management (PBM), a key service offered by Elevance Health, the U.S. market is also considerable. The U.S. pharmacy benefit management market size was valued at USD 482.4 billion in 2022 and is expected to expand at a CAGR of 8.77% from 2023 to 2030, reaching USD 934.0 billion by 2030. Other analyses show the U.S. PBM market valued at USD 587.4 billion in 2024, projected to be USD 638.0 billion in 2025. Another estimate for the U.S. pharmacy benefit management market size was USD 419.14 billion in 2024, with a projection to reach around USD 1,041.11 billion by 2034 at a CAGR of 9.53% from 2025 to 2034.

Elevance Health also provides care management solutions, and the U.S. market for these services is growing. The U.S. care management solutions market size was valued at USD 6.63 billion in 2024 and is projected to grow at a CAGR of 14.1% from 2025 to 2030, reaching USD 14.50 billion by 2030. Another assessment places the U.S. care management solutions market size at USD 4.43 billion in 2024, predicted to be worth approximately USD 16.30 billion by 2034, expanding at a CAGR of 13.9% from 2025 to 2034.

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Elevance Health (ELV) is expected to drive future revenue growth over the next 2-3 years through several key strategies:

1. Growth in Health Benefits Business: The company anticipates revenue growth from higher premium yields and rate adjustments within its Health Benefits segment. This includes targeted expansion in profitable areas such as Medicare Advantage, with expectations for high single-digit growth in individual Medicare Advantage and double-digit growth in group Medicare Advantage by 2025. Elevance Health also sees growth in its BlueCard and Affordable Care Act (ACA) membership.

2. Expansion of Carelon Segment and Healthcare Services: Elevance Health is focused on scaling its Carelon segment, which includes CarelonRx and Carelon Services. This involves continued growth in pharmacy customers and expanding value-based care solutions. Recent acquisitions, such as BioPlus and CareBridge, are integral to enhancing and expanding home-based and pharmacy services, contributing to double-digit top-line growth in CarelonRx.

3. Strategic Acquisitions: Future revenue will also be bolstered by strategic acquisitions. The company has cited the impact of the BioPlus acquisition and the CareBridge acquisition in expanding its service offerings and customer base. The acquisition of Blue Cross and Blue Shield of Louisiana is also expected to contribute to growth once finalized.

4. Improving Medicare Advantage Star Ratings: Elevance Health is making significant investments and efforts to improve its Medicare Advantage Star ratings. The goal is to have approximately 55% of its Medicare Advantage members in 4-Star or higher contracts for the 2027 payment year, a substantial increase from previous levels. Higher Star ratings are crucial for member retention, attracting new members, and enhancing reimbursement from the Centers for Medicare & Medicaid Services (CMS).

5. Digital and AI Innovation: Strategic investments in digital innovation and artificial intelligence (AI) are expected to drive long-term efficiency and improve the member experience. Initiatives include developing HealthOS, AI-enabled clinical support, and digital virtual assistants. While primarily focused on optimizing costs and operational efficiency, these technological advancements can indirectly support revenue growth by improving the attractiveness and competitiveness of Elevance Health's offerings, leading to better member satisfaction and retention.

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