Elevance Health
Elevance Health, Inc. is an American health insurance and healthcare services company headquartered in Indianapolis, Indiana. Known as Anthem, Inc. until June 2022, it is the largest for-profit managed care company in the Blue Cross Blue Shield Association and among the largest health insurers in the world by revenue. It provides medical, pharmacy, dental, behavioural health, long-term care and disability coverage through affiliates including Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint and Carelon, and served approximately 45 million members across its health plans in the mid-2020s.
| Elevance Health, Inc. | |
|---|---|
| Type | Public |
| Traded as | NYSE: ELV; S&P 500 component |
| Industry | Managed health care, health insurance |
| Founded | 1946 as Mutual Hospital Insurance Inc., Indianapolis; present form from the 2004 Anthem-WellPoint merger |
| Headquarters | Indianapolis, Indiana, United States |
| Area served | United States and Puerto Rico |
| Key people | Gail Koziara Boudreaux (president and chief executive), Mark Kaye (chief financial officer) |
| Products | Health insurance, pharmacy benefit management, behavioural health, care delivery, health services |
| Revenue | Approximately US$175 billion (2024) |
| Employees | Approximately 104,000 |
| Website | elevancehealth.com |
The company holds the Blue Cross or Blue Shield licence, or both, in fourteen states, giving it a position in each that is difficult to displace, since the Blue brands carry very high recognition and the licences are exclusive within their territories. Outside those states it operates Medicaid and Medicare plans under the Wellpoint name, and it has built a health services business, Carelon, that supplies pharmacy benefit management, behavioural health, specialty benefit management and care delivery both to its own plans and to other insurers.
Its 2022 change of name from Anthem to Elevance reflected a strategic position that the company is no longer only an insurer, and that its growth would come from services sold alongside coverage rather than from coverage alone, a direction pursued by every large American health insurer in the same period.
History
Anthem in Indiana, 1946 to 2004
The company began in Indianapolis in 1946 as Mutual Hospital Insurance Inc. and Mutual Medical Insurance Inc., two non-profit mutual organisations of the kind established across the United States in the 1930s and 1940s to allow subscribers to pre-pay for hospital and physician care. They grew to control about 80 per cent of the medical insurance market in Indiana by the 1970s, and in 1972, operating as Blue Cross of Indiana and Blue Shield of Indiana, entered a joint operating agreement.
In 1985 the two merged into Associated Insurance Companies, Inc., later the Associated Group, a holding company, although the Anthem name remained in use. It bought American General Insurance Co. for US$150 million in 1989 and the Shelby Insurance Co. of Ohio for US$125 million in 1991, and founded Acordia in 1989 as an insurance and employee benefits brokerage. Acordia acquired American Business Insurance for US$130 million and the Federal Kemper Insurance Company for US$100 million in 1993, the year in which the Associated Group merged with Southeastern Mutual Insurance Company, operator of Blue Cross and Blue Shield of Kentucky. In 1994 it sold Raffensperger, Hughes and Co., Indiana's largest investment bank, to National City Corporation.
The consolidation of Blue plans that defined the company's growth began in 1995, when the Associated Group acquired Community Mutual Insurance, the Ohio Blue plan with more than 1.9 million policyholders, and established Anthem Blue Cross and Blue Shield. It renamed itself Anthem Insurance Company in 1996. In August 1997 it acquired Blue Cross and Blue Shield of Connecticut and sold Acordia to its management. In 1999, using debt financing, it acquired the New Hampshire, Colorado and Nevada Blue plans; the acquisitions made since 1996 had added 850,000 policyholders, and the customer base included 2.4 million preferred provider organisation and 964,000 health maintenance organisation enrollees. Blue Cross Blue Shield of Maine followed in 2000.
The Gramm-Leach-Bliley Act of 1999 made it possible for Anthem to demutualise, converting from an organisation owned by its policyholders into a shareholder-owned corporation. It completed an initial public offering in 2001, becoming the fourth-largest publicly traded managed care company in the United States. Demutualisation was contested across the Blue system throughout this period, because the plans had been built with tax exemptions and community support on the understanding that they served subscribers rather than investors, and conversions generally required regulators to direct a portion of the value into charitable foundations.
In 2002 Anthem acquired Trigon Healthcare of Virginia, the largest insurer in that state, for US$4.04 billion, taking membership to 11.9 million.
Blue Cross of California and WellPoint
The company's other lineage runs through California. Blue Cross of California was formed in 1982 by the consolidation of Blue Cross of Northern California, established in 1936, and Blue Cross of Southern California, established in 1937. In 1992 WellPoint was created to operate its managed care business, and in January 1993 Blue Cross of California spun that business off as the publicly traded WellPoint Health Networks Inc., retaining an 80 per cent interest and voting control. In 1996 Blue Cross of California restructured as a for-profit corporation with WellPoint Health Networks as parent, a conversion that led to the creation of two of the largest healthcare foundations in the United States, the California Endowment and the California HealthCare Foundation, endowed with the value that had accumulated in the non-profit.
WellPoint then expanded rapidly by acquisition. In April 1996 it bought the group life and health subsidiaries of Massachusetts Mutual for about US$380 million, becoming the second-largest publicly held managed care company with four million policyholders. In March 1997 it acquired the group health and life businesses of John Hancock Financial for US$86.7 million, extending into Michigan, Texas and the mid-Atlantic and gaining a unit serving large employers.
In 2000 it acquired PrecisionRx, a mail-order pharmacy operation in Texas, and Rush Prudential Health Plans of Chicago for US$204 million. In March 2001 it acquired Cerulean Companies, parent of Blue Cross Blue Shield of Georgia. In 2001 it offered US$1.37 billion for CareFirst BlueCross BlueShield, including US$119 million in bonuses to CareFirst executives; the Maryland insurance commissioner rejected the transaction in 2003, largely because of the payments to executives and the loss of the non-profit's charitable character.
In 2002 WellPoint acquired RightChoice Managed Care, which operated Blue Cross and Blue Shield in part of Missouri and owned the provider network business HealthLink, for US$1.5 billion, together with MethodistCare of Houston. In 2003 it acquired Golden West Dental and Vision and Cobalt, including Blue Cross and Blue Shield United of Wisconsin.
WellPoint, Inc., 2004 to 2014
In November 2004 Anthem Insurance Company and WellPoint Health Networks merged, structured as Anthem acquiring WellPoint and taking its name, to form WellPoint, Inc. The combined company sold Blue Cross and Blue Shield products in eleven states and continued to use Anthem as the operating brand. The transaction created the largest health insurer in the United States by membership and consolidated a substantial share of the Blue system under a single for-profit owner.
Acquisitions continued. In 2005 WellPoint bought Lumenos, a pioneer of consumer-driven health plans, for US$185 million, and WellChoice, the New York Blue plan, for approximately US$6.5 billion, making New York its fourteenth Blue licence state. In 2007 it acquired American Imaging Management, a radiology benefit management company whose software directed patients to lower-cost imaging providers, a business that became the foundation of what is now Carelon's specialty benefit management. In 2008 it acquired Resolution Health, which analysed patient histories for risks such as adverse drug interactions, and in 2009 DeCare Dental.
In 2011 it acquired CareMore, a California company operating insurance plans and clinics for elderly patients, an early move into the direct provision of care rather than only its financing. In 2012 it acquired Amerigroup for US$4.9 billion in anticipation of the expansion of Medicaid under the Patient Protection and Affordable Care Act, a judgement that proved correct: Medicaid managed care became one of the fastest-growing parts of the industry as states contracted the administration of their programmes to private insurers.
Leslie Margolin served as president of California operations from January 2008 until her resignation in July 2010, having publicly questioned the company's rate increases in that state. Angela Braly resigned as chief executive in August 2012 under pressure from investors following weak results and criticism of the company's handling of the Affordable Care Act.
On 13 August 2014 WellPoint announced that it would take the Anthem name, effective that December.
Anthem, Inc., 2014 to 2022
In February 2015 Anthem acquired Simply Healthcare Holdings, a Florida Medicaid and Medicare managed care company. In June 2015 it offered more than US$54 billion in cash and stock for Cigna, one of two mergers announced that summer that would have reduced the number of large national health insurers from five to three, the other being Aetna's proposed acquisition by Humana.
Both were blocked. On 8 February 2017 the federal district judge Amy Berman Jackson enjoined the Anthem-Cigna merger on antitrust grounds, finding that it would substantially lessen competition in the market for health insurance sold to large national employers. Cigna terminated the agreement on 14 February and the two companies then litigated against each other over termination fees for several years, with the Delaware Court of Chancery eventually ruling that neither owed the other.
In October 2017 Anthem announced that it would not renew its pharmacy benefit management arrangement with Express Scripts, saying it had been overcharged by US$3 billion, and would instead build its own capability through a new unit called IngenioRx while contracting with CVS Health for five years of processing. Cigna announced in March 2018 that it would acquire Express Scripts for US$58 billion, completing a reconfiguration in which each of the large insurers came to own its own pharmacy benefit manager. The economics of that business, in which a manager negotiates rebates from drug manufacturers and retains part of them, have been among the most criticised features of American healthcare, and owning one internalises both the savings and the criticism.
Gail Koziara Boudreaux, previously chief executive of UnitedHealthcare, was named chief executive on 6 November 2017. In 2018 the company announced a US$20 million expansion of its Indianapolis headquarters and leased a technology centre in Atlanta.
In March 2020 Anthem acquired Beacon Health Options, the largest independently held behavioural health organisation in the country. On 2 February 2021 it agreed to acquire InnovaCare Health's Puerto Rico subsidiaries, including MMM Holdings and its Medicare Advantage plan. In November 2021 it agreed to acquire Integra Managed Care in New York, completing on 5 May 2022.
Elevance Health, 2022 to present
On 28 June 2022 Anthem became Elevance Health, changing its ticker from ANTM to ELV. The name, combining elevate and advance, was intended to signal a business extending beyond insurance into health services, and the Anthem brand was retained for the Blue-licensed insurance plans, where its recognition is an asset.
On 23 January 2023 Elevance agreed to acquire Blue Cross and Blue Shield of Louisiana, which would extend its footprint to fifteen states and add 1.9 million members. The transaction was withdrawn and re-proposed after opposition in Louisiana, where policyholders of the non-profit plan would have received payments in exchange for its conversion, and became a further instance of the long-running dispute over whether Blue plans built as community institutions should pass into shareholder ownership.
In 2023 the company announced that its Amerigroup Medicaid and Medicare business would be rebranded as Wellpoint from 2024, reviving a name it had discarded a decade earlier, so that its non-Blue plans would carry a single identity distinct from Anthem.
The middle years of the decade were difficult for the managed care industry. Medical cost trends rose faster than insurers had priced for, particularly in Medicaid, where states redetermined eligibility after the end of pandemic-era continuous enrolment and the members who remained were on average sicker than those who left, and in Medicare Advantage, where utilisation of outpatient procedures rose sharply. Elevance reduced its earnings guidance in 2024 and again in 2025, and the sector's share prices fell substantially.
Business
Elevance reports through four segments.
Health Benefits comprises the insurance business, covering commercial plans sold to employers and individuals, Medicare Advantage and supplemental Medicare products, and Medicaid managed care contracted with states. Commercial business is further divided between fully insured plans, in which the company bears the risk of medical costs, and administrative services only arrangements, in which a large employer bears its own risk and pays Elevance to administer the plan, process claims and provide access to its negotiated provider network. The second is lower in revenue and risk but is the source of a substantial share of the membership.
CarelonRx is the pharmacy benefit manager, formerly IngenioRx, which negotiates with drug manufacturers, operates formularies determining which medicines are covered and on what terms, and runs mail and specialty pharmacies.
Carelon Services provides behavioural health management, specialty benefit management in areas such as radiology, oncology, musculoskeletal care and post-acute care, complex care management and, increasingly, the direct delivery of care through primary care and advanced primary care practices. Carelon Global Solutions provides business process outsourcing and shared services for the group from sites in India, the Philippines, Puerto Rico and the United States.
Corporate and Other covers remaining activities.
The strategic logic of the Carelon build-out follows that of UnitedHealth's Optum, which by the 2020s generated more profit than its insurance arm. Owning the entities that manage and deliver care allows an insurer to capture margin at several points in the same dollar of healthcare spending and to influence utilisation directly rather than through claims review. Regulators, providers and legislators have raised concerns that the arrangement gives insurers incentives to steer patients toward their own affiliated providers and complicates the measurement of what is actually spent on care.
Regulation
American health insurers operate under state insurance regulation, federal rules for Medicare and Medicaid, and the requirements of the Affordable Care Act. Among the most significant is the medical loss ratio rule, which requires insurers to spend at least 80 per cent of premium revenue in the individual and small group markets, and 85 per cent in the large group market, on medical care and quality improvement, rebating the difference to customers. The rule caps the proportion of premium that can become administrative cost and profit, and has been credited with one of the structural reasons insurers have moved into health services: revenue earned by a subsidiary providing care counts as medical spending rather than as overhead.
Medicare Advantage, in which the government pays private insurers a capitated amount per enrollee adjusted for the member's recorded health conditions, has become the largest source of growth and the largest source of regulatory difficulty for the industry. Payments rise with documented diagnoses, which creates an incentive to record them comprehensively, and federal audits, investigations by the Department of Justice and reports by the inspector general of the Department of Health and Human Services have found widespread evidence of diagnoses recorded without corresponding treatment. Several large insurers including Elevance have faced False Claims Act litigation over risk adjustment practices, and the government has tightened audit methods and adjusted the payment model.
The Blue Cross Blue Shield Association itself was the subject of antitrust litigation alleging that the exclusive service areas assigned to each plan, and the restrictions on competing outside them or under other brands, constituted an unlawful division of the market. The association and its member plans settled with subscribers for US$2.67 billion in 2022 and with healthcare providers for US$2.8 billion in 2024, and agreed to structural changes including the removal of the cap on revenue member plans may earn from non-Blue business. Elevance, as the largest for-profit licensee, bore a substantial share of both settlements.
Membership and operations
Elevance holds the Blue Cross licence, the Blue Shield licence, or both, in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri excluding thirty counties around Kansas City, Nevada, New Hampshire, New York, Ohio, Virginia excluding the Washington suburbs, and Wisconsin. Within those states it trades as Anthem Blue Cross and Blue Shield, or in California as Anthem Blue Cross. Outside them it operates Medicaid and Medicare plans under the Wellpoint brand, rebranded from Amerigroup during 2024, together with Simply Healthcare in Florida, HealthSun, MMM in Puerto Rico and Integra in New York.
The membership divides into three broad categories whose economics differ entirely. Commercial members, covered through employers or bought individually, are the historic core; within them, self-insured employers who pay Elevance only to administer their plans contribute large membership and modest revenue, while fully insured employers and individuals contribute both revenue and underwriting risk. Medicare members, principally in Medicare Advantage plans that replace traditional Medicare, are the most valuable per head and the most competitive segment of the market. Medicaid members, enrolled through state contracts, produce large revenue at thin margins that depend on how accurately a state has set its capitation rates against the health of the population enrolled.
The balance among these has shifted markedly. Employer coverage in the United States has grown slowly for two decades while government programmes have grown quickly, and by the mid-2020s government business accounted for a majority of Elevance's medical membership, reversing the position of twenty years earlier. That shift has changed the company's customers: its revenue increasingly comes from state and federal agencies rather than from human resources departments, and its results depend correspondingly on political and budgetary decisions.
Medicaid redeterminations
The most consequential recent operational event was the unwinding of pandemic-era Medicaid rules. Federal legislation in 2020 required states to maintain continuous enrolment in exchange for additional funding, so that no one was removed from Medicaid for three years. When the requirement ended in April 2023, states began redetermining eligibility, and roughly twenty million people lost coverage nationally over the following eighteen months.
For the managed care companies the problem was not principally the loss of members but their composition. Those who left were disproportionately healthy people who had moved to employer coverage or had simply failed to return paperwork, while those who remained were disproportionately the chronically ill. The cost per remaining member rose sharply, and the capitation rates states paid, set from data gathered before the change, did not keep pace. Elevance, along with Centene and Molina, reported deteriorating Medicaid margins through 2024 and 2025 and reduced its earnings guidance repeatedly, and the sector entered its most sustained period of negative sentiment since the Affordable Care Act was passed.
Finances
Elevance reported revenue of approximately US$175 billion in 2024, making it among the largest companies in the United States by that measure and the seventh largest healthcare company in the world. Health insurance revenue is inflated relative to other industries because premium income passes through the accounts before medical claims are paid out of it; net margins in managed care are typically in the range of three to five per cent, low by the standards of other large American companies and a point the industry emphasises when accused of profiteering.
The counter-argument is that a low margin on an extremely large base still produces very substantial absolute profit, that the medical loss ratio rules cap margins on insurance but not on the services businesses that now sit alongside it, and that the return on capital rather than the return on revenue is the appropriate measure for a business that holds comparatively few assets.
The company has returned substantial cash to shareholders through dividends and buybacks, and has used acquisitions rather than organic expansion as its principal growth mechanism throughout its history, a pattern visible in almost every year since 1989.
Corporate affairs
Leadership
Gail Koziara Boudreaux has been president and chief executive since November 2017. Before joining she had led UnitedHealthcare, the largest health insurer in the country, and earlier held senior positions at Aetna and Health Care Service Corporation; she is among the small number of women to have led a company of this size and is a former college basketball player whose records at Dartmouth stood for decades.
Her predecessors include Joseph Swedish, chief executive from 2013 to 2017, who came from hospital administration rather than insurance; Angela Braly, from 2007 to 2012; Larry Glasscock, who led Anthem through the WellPoint merger; and Leonard Schaeffer, who ran Blue Cross of California and WellPoint Health Networks and directed the conversion of the California plan to for-profit status, an operation that made him one of the more influential and contested figures in the modern American health insurance industry.
Employees and locations
The company employs approximately 104,000 people. Its headquarters occupy a campus in downtown Indianapolis, where it is among the largest private employers, and it operates a technology centre in Atlanta and major offices in Virginia, Ohio, California, Connecticut and Missouri. Carelon Global Solutions employs a large workforce in India and the Philippines performing claims processing, customer service and technology development, part of a general movement of health insurance administration offshore that has accelerated as the companies have sought to reduce the administrative share of premium constrained by the medical loss ratio rules.
Philanthropy
The Elevance Health Foundation, formerly the Anthem Foundation, funds programmes in maternal health, food security, disaster relief and health equity, and has committed sums in the tens of millions of dollars to reducing maternal mortality in particular, an area in which American outcomes are conspicuously poor relative to comparable countries and markedly worse for Black women.
The conversions of non-profit Blue plans into parts of the company also created several of the largest health-focused charitable foundations in the United States. The 1996 California conversion endowed the California Endowment and the California HealthCare Foundation, now the California Health Care Foundation, with assets exceeding four billion dollars between them, and comparable, smaller foundations were created by conversions in other states. These institutions have become significant independent funders of health policy research, including research critical of the industry that created them.
Competition
Elevance competes principally with UnitedHealth Group, the largest health insurer and, through Optum, the largest health services business in the country; CVS Health, which owns Aetna and the largest retail pharmacy chain; Cigna, which owns Evernorth and Express Scripts; Humana, concentrated in Medicare Advantage; Centene and Molina in Medicaid; and the other Blue Cross Blue Shield licensees, which are mostly non-profit and which, under the association's rules, do not compete with it inside its licensed territories.
The structure of the market is unusual. In most states a small number of insurers hold the majority of commercial enrolment, and in many a single Blue plan holds more than half. This concentration gives insurers substantial leverage in negotiating prices with hospitals, which have themselves consolidated into large systems with corresponding leverage in the other direction. The resulting bargaining between two concentrated parties determines the prices paid for most medical care in the United States, and the outcome is prices substantially higher than in any comparable country without corresponding differences in outcome, a finding consistent across the health economics literature.
Technology and artificial intelligence
Elevance has invested in analytics for care management, fraud detection and risk stratification, and has described artificial intelligence as central to reducing administrative cost. Like its competitors it uses algorithmic tools in utilisation management, which has attracted scrutiny: litigation and reporting concerning several insurers has alleged that automated systems were used to deny post-acute care claims at scale with limited clinician review, and legislators in several states have introduced requirements that a qualified clinician make any adverse medical necessity determination.
The company has also invested in digital member services, in interoperability required by federal rules obliging insurers to make claims and coverage data available to members through application programming interfaces, and in the electronic prior authorisation systems that federal regulation will require from the late 2020s.
Criticism
Coverage denials and prior authorisation
Like all large American insurers, Elevance has been criticised over the denial of claims and over prior authorisation, the requirement that a treatment be approved before it is provided. Physicians' organisations have argued that the volume of prior authorisation requests delays care and consumes clinical time, and state and federal regulators have introduced requirements for faster decisions and electronic processing.
Public hostility toward health insurers reached an unusual intensity in December 2024 following the killing of the chief executive of UnitedHealthcare in Manhattan, which prompted a volume of online commentary hostile to the industry that the companies themselves found alarming. Within days Anthem Blue Cross and Blue Shield reversed a policy, announced for several states, that would have limited payment for anaesthesia to a predetermined time for a given procedure regardless of how long the operation actually took, saying the policy had been widely misinterpreted. The episode illustrated both the low public standing of the industry and the speed with which insurers had come to respond to it.
Ghost networks
As of 2025 the Elevance subsidiaries Carelon Behavioral Health and Anthem Blue Cross and Blue Shield were defendants in three lawsuits in New York and Connecticut alleging the operation of ghost networks, meaning published directories of in-network providers who are not in fact available, do not accept the insurance or are no longer practising. The practical effect is that a plan appears to offer access to mental health care that a member cannot actually obtain, which if established would breach federal parity requirements obliging insurers to cover mental health on terms comparable to physical health. Studies by regulators and academics have found that a large proportion of listed behavioural health providers across the industry are unreachable or unavailable, and the issue has become one of the principal enforcement priorities in health insurance regulation.
The 2015 data breach
In February 2015 Anthem disclosed that attackers had taken personal records relating to approximately 78.8 million current and former members and employees, including names, dates of birth, addresses, email addresses, employment information and Social Security numbers, though not medical records or payment information. It was at the time the largest breach of healthcare data in history.
The intrusion began with a phishing email that compromised credentials at a subsidiary and proceeded undetected for weeks. Investigators attributed it to a state-sponsored group operating from China, and two Chinese nationals were later indicted. Anthem agreed a US$115 million class action settlement in 2017, the largest data breach settlement to that date, and a US$16 million settlement with the Department of Health and Human Services in 2018 for violations of the Health Insurance Portability and Accountability Act, also a record. A further US$39.5 million settlement with state attorneys general followed in 2020.
Rate increases and market conduct
The company has repeatedly been the subject of public disputes over premium increases, most prominently in California in 2010, when Anthem Blue Cross proposed increases of up to 39 per cent for individual policyholders. The proposal became a national issue during the final stage of the debate over the Affordable Care Act, was cited by President Barack Obama in support of the legislation, and was withdrawn after an independent actuarial review found errors in the calculation. The episode contributed directly to the rate review provisions included in the resulting statute.