Anthem, Inc., through its subsidiaries, operates as a health benefits company in the United States. It operates through three segments: Commercial and Specialty Business, Government Business, and Other. The company offers a spectrum of network-based managed care health benefit plans to large and small employer, individual, Medicaid, and Medicare markets. Its managed care plans include preferred provider organizations; health maintenance organizations; point-of-service plans; traditional indemnity plans and other hybrid plans, such as consumer-driven health plans; and hospital only and limited benefit products. The company also provides a range of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs, and other administrative services. In addition, it offers an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management, and analytics-driven personal health care guidance; and Medicare administrative services. Further, the company provides services to the federal government in connection with the Federal Employee Program; and operates as a licensee of the Blue Cross and Blue Shield Association. As of December 31, 2016, it served 39.9 million medical members through its affiliated health plans. The company was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in December 2014. Anthem, Inc. was founded in 1944 and is headquartered in Indianapolis, Indiana.
Business Analysis of Anthem
The Healthcare Services Sector is witnessing a major shakeup, new age business models in the industry are transforming both customers and businesses. Faced with this uncertainity, companies are investing resources to transform their business. An in-depth business analysis is a valuable resource to identify and articulate the need for a business model change. At R&P Research we believe, the starting point for a business analysis is Benchmarking. Business benchmarking can be done at various levels: 1) Industry Benchmarking 2) Peer Benchmarking 3) Disruptors Benchmarking. In this report, we share the snapshot of how Anthem compares against the industry on the major performance indicators. This analysis, along with peer group/disruptors benchmarking and revenue model understanding can help identify growth and cost optimization opportunities to maximize the value delivered by Anthem to its stakeholders. R&P Research Industry Intelligence Platform provides historical data for last 15 years with an easy to use benchmarking interface for an in-depth comparative business analysis.
Here is the performance snapshot of Anthem with an interactive chart.
- Revenue Growth: Anthem reported a revenue growth of 7.2% year-on-year during 2016. Healthcare Payers Industry grew at 13.5% in the same period
- COGS share of Revenues: As a percentage of revenue, Anthem spent 78.8% of its total revenues on COGS. Healthcare Payers industry average (COGS share of revenue) in the same period was 78.2%
- R&D share of Revenues: Anthem R&D share of Revenues details are not available because either company does not share the data or we do not have it
- SG&A share of Revenues: As a percentage of revenue, Anthem spent 14.8% of its total revenues on Sales, Marketing, and General Administration (SG&A). Healthcare Payers industry average SG&A spending in the same period was 15.1%
- Inventory share of Revenues: Anthem Inventory share of Revenues details are not available because either company does not share the data or we do not have it
- Accounts Payable share of Revenues: As a percentage of revenue, Anthem invested 15.4% of its total revenues on Accounts Payable (A/P) Healthcare Payers industry average Accounts Payable investment in the same period was 13.9%
- Accounts Receivable share of Revenues: As a percentage of revenue, Anthem invested 9.9% of its total revenues on Accounts Receivable (A/R). Healthcare Payers industry average Accounts Receivable investment in the same period was 9.0%
- PP&E share of Revenues: As a percentage of revenue, Anthem invested 2.3% of its total revenues on Property, Plants, and Equipments (PP&E). Healthcare Payers industry average PPE investment in the same period was 2.6%
- Intangibles share of Revenues: As a percentage of revenue, Anthem invested 30.1% of its total revenues on Intangibles. Healthcare Payers industry average Intangibles investment in the same period was 21.9%
- Net Margins: Anthem Net Margins in the year 2016 were 2.9%. Healthcare Payers industry average Net Margins in the same period were 3.0%
Sector and Industry Association of Anthem
For the purpose of performance benchmarking of a company with a sector or industry average, R&P Research associates every company with one sector and one industry. An industry consists of companies with related/similar business models. A sector comprises of a group of related/similar industries. For high-level analysis purposes, related/similar sectors are grouped into sector groups.
Anthem is associated with Healthcare Sector Group, Healthcare Services Sector, and Healthcare Payers Industry.
Healthcare Services sector is comprised of the following industries: Drug Stores, PBM and Distributors; Healthcare Payers; Healthcare Providers; Medical Software; Healthcare Research Services. The definitions for each of the industries is as follows:
- Drug Stores, PBM and Distributors industry includes nationwide drugstore chains, pharmacy benefit management (PBM) companies, and drug distributors. Drug stores also offer walk-in clinics and related pharmacy services. Distributors distribute branded and generic pharmaceutical and other healthcare products to hospitals, pharmacies and other healthcare providers. PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.
- Healthcare Payers industry includes healthcare insurance companies that finance or reimburse the cost of health services. These companies also offer collaborative care, population health management, healthcare technology, Pharmacy Benefit Management, analytics, consulting and administrative services.
- Healthcare Providers industry consist primarily of hospitals but recent changes in the health services industry have contributed to both increasing numbers of other types of facility providers. Companies in this industry include traditional healthcare providers and emerging healthcare facility providers like ambulatory surgery centers, behavioral healthcare facilities, dialysis clinics, home health care companies and others.
- Medical Software industry includes companies that offer any software item or system used within a healthcare context. These companies offer standalone software used for diagnostic, therapeutic purposes, clinical financial and operational purposes.
- Healthcare Research Services industry includes companies that offer biopharmaceutical development services, commercial outsourcing services; commercial pharmaceutical sales and service organizations, consulting, health information analytics and technology consulting.
Industry Ranking of Anthem
With $84.9 billion revenues, Anthem ranked number 2 of all the companies in the US Healthcare Payers industry. There were a total of 14 public companies in the US Healthcare Payers industry that had revenues greater than $50 million during 2016.
The top-10 companies in the US Healthcare Payers industry by revenues during 2016 were:
Business Model Analysis (BMA) Framework
We use the following framework to assess the business model of a company. Business Model Analysis framework can be used by organizations to articulate growth strategies and identify cost optimization opportunities. Technology and consulting companies can use this framework to identify the value drivers and pain points of their targeted customers. Entrepreneurs can use this framework to understand the language of business and identify promising business opportunities. This framework can be used by any professional aspiring to take up a leadership role to better understand the businesses challenges, articulate growth strategy, and monitor the business improvement requirements for the organization.