Carelon

What Carelon does

Carelon is the healthcare services division of Elevance Health (NYSE: ELV), launched in 2022 to consolidate and integrate pharmacy, behavioral health, medical benefits management, palliative care, payment integrity, and operations/digital transformation services under one platform. It serves health plans (including Elevance's own ~104M consumers), self-insured employers, federal and state government agencies (Medicare/Medicaid), and provider organizations across all 50 states through enterprise B2B contracting.

Carelon's core offering is a multi-service-line healthcare services platform: CarelonRx (PBM with specialty pharmacy including BioPlus and the 2024-acquired Kroger Specialty Pharmacy), Carelon Behavioral Health, Carelon Medical Benefits Management (formerly AIM Specialty Health, covering radiology, oncology, cardiovascular, genetic testing, post-acute care), Carelon Palliative Care, Carelon Payment Integrity (formerly 4600Boehm), and Carelon Global Solutions (BPO/digital transformation with 29,000+ associates across India, Ireland, the Philippines, Puerto Rico, and the U.S.). Underlying these is the Carelon Research division and its Healthcare Integrated Research Database (HIRD®), containing integrated data across 80M+ lives used for ML-driven predictive modeling, real-world evidence, and AI-enabled care routing.

The business generates revenue through managed services fees (PBM/PBM-adjacent contracts, BPO), transaction and recovery fees (payment integrity), value-based total-cost-of-care contracts (e.g., firsthand SMI partnership), and capitation-style contracting for serious-illness and home-based care. GTM is enterprise field sales to payers, employers, and government, supplemented by direct provider partnerships (e.g., Interim HealthCare for 41-state home health). The 2025 acquisitions of CareBridge and Paragon Healthcare drove a reported 33% jump in Q3 operating revenue, signaling an aggressive inorganic growth posture alongside continued investment in AI-enabled chronic care and specialty pharmacy expansion.

Name

Carelon

Legal name

Carelon Healthcare Services Company

Website

https://carelon.com

Company type

Private

Founded year

2022

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

Carelon is Elevance Health's healthcare services division, providing pharmacy benefit management, behavioral health, medical benefits management, palliative care, payment integrity, and digital operations to health plans, employers, government agencies, and providers across all 50 states.

Ownership category

akta.pro rank

Headquarters

HQ city

Indianapolis

HQ country

United States

HQ region

North America

Offices7 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales

Revenue model

1. Pharmacy Services (CarelonRx): CarelonRx provides pharmacy benefits management including specialty pharmacy, home delivery, and clinical condition management. Revenue is generated through pharmacy benefit management fees, prescription dispensing, and cost management solutions for health plans and employers. The business unit generated significant revenue growth, including a 33% increase in Q3 operating revenue driven by acquisitions in home health and pharmacy services.
2. Value-Based Care / Total Cost of Care Contracting: Carelon enters full-risk partnerships where it assumes responsibility for the complete cost of care including behavioral health, physical health, pharmacy, and hospital services. Revenue is generated through negotiated capitation or performance-based contracts with health plans, aligning incentives around patient outcomes and cost management.
3. Medical Benefits Management: Carelon's Medical Benefits Management solutions provide utilization management, clinical appropriateness review, and specialty care management (oncology, cardiology, radiology, musculoskeletal) for health plans, generating fees for clinical decision support and administration services.
4. Payment Integrity Services: Carelon Payment Integrity (including former 4600Boehm) provides claims payment accuracy solutions including data mining, subrogation, and other party liability identification. Revenue is generated through savings recovery arrangements and service fees with health plans.
5. Operations and Digital Transformation (Carelon Global Solutions): Carelon Global Solutions provides business process outsourcing and technology-enabled operations for health plans, including claims management, provider network solutions, customer experience, risk adjustment, and clinical operations. Revenue is generated through managed services contracts and outsourcing fees.

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

Carelon is a healthcare services company that delivers an integrated suite of clinical and operational capabilities to health plans, employers, government agencies, and providers. Its offerings span pharmacy benefit management and specialty pharmacy (CarelonRx, BioPlus), behavioral health, medical benefits management, palliative care, payment integrity, care navigation, and healthcare research and analytics, enabled by its Healthcare Integrated Research Database (HIRD) with 80M+ lives of data. The company operates as the healthcare services arm of Elevance Health, applying predictive analytics, AI, and clinical expertise to lower costs and improve outcomes across the care continuum.

Product overview

Carelon is a healthcare services organization offering an integrated platform of clinical and operational capabilities designed to make care more connected, personalized, and affordable. The portfolio consists of core service lines including CarelonRx (pharmacy benefit management with specialty pharmacy via BioPlus and home delivery through CarelonRx Pharmacy), Carelon Behavioral Health, Care Navigation, Palliative Care, and Payment Integrity solutions. Underpinning these is the Medical Benefits Management (MBM) platform—covering radiology, cardiovascular, oncology, genetic testing, post-acute care, and durable medical equipment—along with Operations & Digital Transformation services and Carelon Research's Healthcare Integrated Research Database (HIRD) for analytics. The company, launched in 2022 as part of Elevance Health, serves health plans, employers, government agencies, and individuals across all 50 states.

Differentiator

Problem solved

Functional benefit

Brands

• CarelonRx: Pharmacy benefit management (PBM) and specialty pharmacy services
• BioPlus Specialty Pharmacy
• Carelon Research
• Carelon Medical Benefits Management
• Carelon Payment Integrity

Products and services

• CarelonRx Pharmacy benefit manager providing specialty condition management, member digital engagement tools, home delivery, and clinical pharmacy services for health plans and employers.
• Carelon Behavioral Health Behavioral health services platform providing access to behavioral health providers and specialists for health plan members.
• Carelon Research Health research and analytics division maintaining the Healthcare Integrated Research Database (HIRD) with 80M+ lives, conducting health economics, outcomes research, epidemiology, and clinical research.
• Carelon Medical Benefits Management Specialty care management platform providing utilization management and clinical appropriateness review across radiology, cardiovascular, oncology, genetic testing, post-acute care, sleep, musculoskeletal, and durable medical equipment.
• Carelon Palliative Care Community-based palliative care services for patients with serious illness providing 24/7 support, symptom management, in-home services, caregiver resources, advance care planning, and virtual services across multiple states.
• Carelon Payment Integrity Claims payment accuracy solutions including data mining, subrogation, other party liability identification, and fraud, waste, and abuse detection for health plans.
• Care Navigation Care coordination and navigation services helping members access appropriate care settings and connect with providers.
• Carelon Operations and Digital Transformation Business process transformation services including provider network solutions, claims management, customer experience, risk adjustment, quality performance, and clinical operations, delivered through Carelon Global Solutions.
• BioPlus Specialty Pharmacy Specialty pharmacy service optimizing experience for members with complex, chronic conditions and improving access to specialty medications.
• CarelonRx Pharmacy Digital-first pharmacy solution offering affordable, personalized pharmacy care with home delivery and 24/7 access to pharmacy experts.

Quantifiable outcome

• 56% reduction in hospital admissions through integrated palliative care approach (internal data, study period Jan 2021–Dec 2022 vs 2019 baseline)
• +11 more outcomes

Named customers3 records

Segments7 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability6 records

Feature5 records

Partnerships

Seven partnerships are on record, tiered core.

• Kroger Specialty PharmacycoreStrategic or Co-development Partner · 4 October 2024CarelonRx, a subsidiary of Elevance Health, completed the acquisition of Kroger Specialty Pharmacy from The Kroger Co. in a $464 million transaction that closed on October 4, 2024 (announced March 2024). The acquisition strengthens CarelonRx's specialty pharmacy capabilities, integrating Kroger's expertise in clinical pharmacy specializing in infusion and mail order services with Elevance Health's resources, to improve health outcomes for patients with chronic conditions across the US.
• firsthandcoreStrategic or Co-development PartnerCarelon has partnered with SMI (serious mental illness) provider firsthand to adopt a total cost of care approach for individuals with serious mental illness. Under the model, firsthand assumes responsibility for the complete cost of care including behavioral health, physical health, pharmacy, and hospital services, while utilizing a peer support model staffed by upskilled workers backed by specialists. The partnership has developed a control group-based performance measurement system and reports positive results after its first year. This partnership exemplifies the rise of full-risk partnerships covering both physical and behavioral health in outcomes-focused value-based care contracting.
• Interim HealthCarecoreStrategic or Co-development PartnerCarelon partnered with Interim HealthCare, a home health provider with 40,000+ professionals across 41 states, to transform post-acute care in the home setting. The partnership enables health plans and their members to benefit from optimized quality and affordability of post-acute home care. The organizations share three core values that have driven their success: collaboration, strategic alignment, and a commitment to whole-person care. The partnership is designed to reimagine home health delivery through clinical best practices, provider collaboration, and advanced analytics.
• CareBridgecoreStrategic or Co-development PartnerCareBridge was acquired by Carelon as part of the healthcare services arm's expansion of value-based care and home-based services, contributing to a 33% jump in Q3 operating revenue.
• Paragon HealthcarecoreStrategic or Co-development PartnerParagon Healthcare was acquired by Carelon as part of the healthcare services arm's expansion of value-based care and home-based services, contributing to a 33% jump in Q3 operating revenue.
• Harvard Pilgrim Health CarecoreStrategic or Co-development PartnerHarvard Pilgrim Health Care, a health plan, partnered with Carelon to implement the Genetic Testing Solution. In less than a year, Harvard Pilgrim achieved remarkable results including reduction in genetic testing spending and reduction in utilization of out-of-network labs. Harvard Pilgrim tailored the solution to meet their unique market needs across six dimensions and the case study demonstrates measurable performance outcomes.
• Elevance HealthcoreStrategic or Co-development PartnerCarelon is the healthcare services division of Elevance Health (formerly Anthem). Carelon was launched in 2022 as part of Elevance Health's strategic transformation from a traditional health insurer into an integrated data-driven health platform. Carelon provides pharmacy, behavioral health, and value-based care services, while CFO Mark Kaye expanded responsibilities in 2026 to include oversight of Carelon alongside his CFO role at Elevance Health.

Scale indicators22 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Evernorth Health Services: Evernorth is Cigna's integrated health services division, anchored by Express Scripts (PBM), eviCore (utilization management), and behavioral/ specialty pharmacy units. It directly mirrors CarelonRx, Carelon Behavioral Health, and Carelon Medical Benefits Management in scope and customer profile.
• Prime Therapeutics: Prime Therapeutics is one of the largest U.S. PBMs, owned by a consortium of Blue Cross Blue Shield plans. It competes with CarelonRx for Blue plan clients and overlapping employer PBM contracts, making it a direct pharmacy-benefit analogue.
• Optum: Optum is the integrated health services platform of UnitedHealth Group, combining pharmacy (OptumRx), care delivery (Optum Health, including DaVita Medical Group), and data/analytics (Optum Insight) — the closest analogue to Carelon's pharmacy + care management + research + BPO stack and its principal strategic competitor.
• eviCore Healthcare (Evernorth): eviCore is the utilization management and specialty benefits management arm of Evernorth/Cigna, covering radiology, cardiology, oncology, and post-acute — directly competing with Carelon Medical Benefits Management for health plan specialty management contracts.
• Magellan Health (Centene): Magellan provides managed behavioral health, specialty health, and pharmacy management to health plans and government agencies — directly comparable to Carelon Behavioral Health and CarelonRx's specialty populations.
• CVS Health (Aetna / Caremark): CVS Health combines the Caremark PBM, Aetna insurance, and MinuteClinic/Oak Street care delivery, competing head-to-head with CarelonRx on PBM scale and with Carelon Medical Benefits Management in specialty utilization management.

Broad incumbents

• Humana / CenterWell: Humana's CenterWell segment operates senior-focused primary care, home health (Kindred at Home), and pharmacy services — directly comparable to Carelon's Palliative Care, CareBridge/Paragon home health, and Medicare Advantage care management focus.
• Centene Corporation: Centene is the largest Medicaid managed-care insurer with growing Medicare and behavioral health exposure (via Magellan). Its government-program focus overlaps Carelon's government agency customer segment and its value-based care contracting model.

Emerging players

• Alignment Healthcare: Alignment Healthcare is a tech-enabled Medicare Advantage plan serving seniors in select states. Its tech-forward, integrated care management approach is comparable to Carelon's AI-driven proactive member engagement and MA-focused chronic care model.
• agilon health: agilon health is a physician-enablement and value-based primary care platform focused on Medicare seniors — comparable to Carelon's first-hand-style total-cost-of-care partnerships and the value-based primary-care vision articulated in Carelon's strategic narrative.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/carelon

Compliance7 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Subsidiaries10 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Carelon