Elevance Health's AI Strategy: How the Anthem Blue Cross Leader Built Member-First Conversational AI

TL;DR#

Elevance Health is the parent company of Anthem Blue Cross Blue Shield and one of the largest health insurers in the United States, with roughly 47 million medical members and $171.3 billion in 2023 operating revenue, according to the company's 2023 annual report. Its AI strategy is shaped by a structural reality competitors do not share: Elevance operates BCBS-licensed plans across 14 different states, each with its own regulators, Medicaid rules, and provider networks. That federated complexity is precisely where static intake forms collapse and where conversational AI insurance experiences win — a form cannot dynamically branch on Indiana versus Virginia Medicaid eligibility, but a conversational agent can. Elevance has invested in the Sydney member experience app, GenAI-assisted underwriting workflows, the Concierge Care care-navigation program, and the Carelon health services platform (behavioral health, specialty pharmacy, post-acute care). The Lemonade lesson applies at BCBS-federation scale: the carriers that treat member intake as a conversation rather than a form will earn the trust, the data depth, and the renewals. Perspective AI helps multi-state payers run that conversational member research without rebuilding 14 separate intake stacks.

Elevance Health at a Glance#

Elevance Health is the publicly traded parent of Anthem Blue Cross Blue Shield, formed when Anthem, Inc. rebranded in June 2022 to reflect a broader health-services strategy beyond traditional payer operations. The company serves approximately 47 million medical members, generated roughly $171 billion in 2023 operating revenue, and ranks as a top-four U.S. health insurer alongside UnitedHealth Group, CVS Health (Aetna), and Cigna, per the company's most recent annual report.

The Anthem Blue Cross Blue Shield brand is licensed in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Elevance also operates Carelon, a separate health services platform housing Carelon Behavioral Health, CarelonRx (pharmacy benefits), Carelon Insights (analytics), and Carelon Global Solutions. Carelon is Elevance's bet that the next decade of payer growth will come from services attached to claims, not the claims themselves.

For comparison with peers, see our case studies on UnitedHealth Group's AI strategy, Cigna's conversational care navigation, Aetna and CVS Health's care-navigation approach, and Kaiser Permanente's integrated-care model.

The 14-State Form Problem at Multi-State Payers#

The 14-state form problem is the operational reality that a single static intake form cannot legally or accurately collect member information across every Anthem-licensed state, because state regulations, Medicaid eligibility rules, network adequacy requirements, and benefit designs vary by jurisdiction. The result, at most multi-state payers, is either a flattened lowest-common-denominator form (which collects too little and frustrates members in stricter states) or 14 parallel intake stacks (which fragment data, increase ops cost, and break analytics).

A few concrete examples of the cross-state divergence Elevance has to navigate:

• Medicaid eligibility floors differ by state. Indiana, Kentucky, Ohio, and Virginia expanded Medicaid; Georgia and Wisconsin did not (Wisconsin uses a partial expansion via BadgerCare). Income thresholds, asset tests, and work-requirement language differ at the state level, according to KFF's state-by-state Medicaid eligibility tracker.
• Network adequacy rules differ by state. California's Department of Managed Health Care enforces time-and-distance standards distinct from New York's prompt-pay and network-adequacy regulations.
• Behavioral health parity enforcement differs by state. California's SB 855 imposes a generally accepted standards of care obligation that exceeds federal parity floors.

A form cannot ask one branch of questions in California, another in Indiana, and a third for a dual-eligible Medicare-Medicaid member in Virginia without becoming so long that completion rates collapse. Conversational AI insurance experiences fix that — they branch dynamically based on state, plan type, and what the member just said. This is the same architectural mismatch we wrote about in Health Insurance AI in 2026: Member Engagement, Claims, and Compliance, and it's the structural reason BCBS-federation carriers have more to gain from conversational interfaces than single-state carriers do.

Where Elevance Is Investing in AI#

Elevance's public AI roadmap clusters around four investment areas, each of which maps to a different point in the member journey. The most strategically interesting are the ones that directly reduce friction at the member-experience layer.

Sydney member experience app. Sydney Health is Anthem's flagship member app, used to find care, check claims, access digital ID cards, and engage virtual primary-care visits. Elevance has progressively layered conversational and AI-assisted features into Sydney — symptom checkers, virtual-care triage, and care-navigation prompts — moving the app from a transactional lookup tool toward a continuous member-engagement surface.

Carelon Behavioral Health AI. Carelon Behavioral Health applies AI to provider matching, crisis triage, and care-plan adherence across behavioral and substance-use programs. Behavioral health is one of the highest-friction service lines in U.S. healthcare because of provider shortages and stigma — both of which conversational interfaces are well-suited to address, since members disclose more to a non-judgmental AI agent than to a clipboard intake at a clinic. The pattern we covered in conversational AI insurance fraud detection — that conversation reveals signal forms can't — applies even more strongly to behavioral health intake.

GenAI-assisted underwriting and operations. Like most large carriers, Elevance has invested in generative AI to support underwriting case review, prior-authorization workflows, and claims operations. The framing matches the broader industry shift we documented in AI underwriting software in 2026 and AI for insurance claims processing: AI is not replacing underwriters or claims adjusters, it is removing the data-collection burden that previously consumed most of their time.

Concierge Care. Concierge Care is Elevance's care-navigation program designed to help members find in-network providers, schedule appointments, and resolve benefit questions without bouncing between phone trees and portals. This is the surface where conversational AI most clearly beats forms — a member asking "is my child's pediatrician still in-network after our plan moved to Anthem HMO?" needs a back-and-forth, not a dropdown.

Conversational AI as the Answer to Multi-State Regulatory Complexity#

Conversational AI is the architecturally correct response to multi-state regulatory complexity because it lets a single member-facing intake or research experience dynamically adjust its questions, disclosures, and routing based on what the member has just said, rather than requiring a separate static form per jurisdiction. This is the BCBS-federation thesis: the more states you operate in, the worse the form gets and the better the conversation gets.

There are three reasons the math works this way:

1. Forms front-load schema, conversations defer it. A form asks every question upfront because it cannot adapt. A conversational agent asks one question, listens, then asks the next — so it can route a California member through California's network-adequacy disclosures and an Ohio member through Ohio's, without showing either to the wrong person.
2. Forms flatten uncertainty, conversations probe it. Multi-state plans have benefits members do not understand. ("Does my Anthem PPO cover an out-of-state behavioral-health telehealth provider?") A form makes that ambiguity invisible; a conversational agent surfaces it and resolves it in-line.
3. Forms produce thin data, conversations produce thick data. Cross-state product, network, and pricing decisions need member-context data forms never capture — why a member switched plans, why they delayed a claim, what they almost did instead. We explored this thesis in Conversational AI in Insurance: Why Deflection Is the Wrong Goal — capturing context, not deflecting volume, is the actual prize.

This is not a hypothetical advantage. AHIP and NCQA have spent the last several years pushing health plans toward higher member-experience scores in CMS Star Ratings (Medicare Advantage) and HEDIS measures, per NCQA's published HEDIS measurement framework. Both rating systems reward plans that engage members earlier and more substantively — which forms cannot do.

Carelon as a Separate Growth Engine#

Carelon is Elevance's separately branded health services platform — a deliberate structural move to build value beyond the regulated insurance P&L. The strategic playbook mirrors what UnitedHealth has done with Optum and what CVS Health has done with Aetna + Caremark + MinuteClinic: stack non-payer services on top of payer data so the lifetime value of a member grows even when premiums are capped.

Carelon's units include:

• Carelon Behavioral Health — provider network, member-facing care navigation, and AI-assisted matching for mental-health and substance-use services
• CarelonRx — pharmacy benefit manager (PBM) competing with CVS Caremark, Express Scripts, and OptumRx
• Carelon Insights — analytics, payment integrity, and value-based-care infrastructure sold to other payers and providers
• Carelon Global Solutions — operations infrastructure (offshore claims, technology services)

The AI thesis here is that Carelon is the place where Elevance can iterate on member-experience innovation faster than the BCBS-licensed insurance entity can. The insurance entity has to clear 14 state regulators and BCBS Association brand guardrails; Carelon's services platform has fewer of those constraints and can be sold to other Blues plans as well. For broader context on the services-platform play, see our commercial insurance AI guide for brokers, MGAs, and carriers.

The Lemonade Lesson, Applied to a BCBS-Federation Carrier#

Lemonade is the most-cited proof point in conversational AI insurance — a digital-native carrier that built its policy-purchase flow, claims FNOL, and member messaging as conversations rather than forms, and used the conversational data to compound an underwriting and CX advantage. We covered the mechanics in the Lemonade conversational AI insurance case study — the fastest-growing AI insurance company in pet insurance got there in large part by replacing the application form with a chat.

The translation to a BCBS-federation carrier like Elevance is not "build a Lemonade-style chatbot." Elevance is 50x Lemonade's scale, with regulated commercial group plans, Medicare Advantage, Medicaid, individual ACA-exchange plans, and ASO (administrative-services-only) employer plans. The translation is:

• Treat member-facing intake — for plan selection, care navigation, prior auth, appeals — as a conversation, not a form. This is the highest-leverage move because intake is where state-level complexity hits the member hardest.
• Use the same conversational layer for outbound research. The same member who just navigated to a behavioral health provider is the right person to ask "what almost stopped you from using this benefit?" — and they will answer a conversational research agent more candidly than they will answer a star-rating survey.
• Compound the data into product, network, and pricing decisions. Member context — why a plan was chosen, why a claim was delayed, why a provider was switched — is the input to better network design and better Medicare Advantage Star Ratings.

This is the same architectural pattern we've documented at carriers as different as USAA, State Farm, Liberty Mutual, and Nationwide. The differences across carriers are tactical; the underlying conversational shift is the same.

How Perspective AI Fits: Conversational Member Research for Multi-State Plans#

Perspective AI is built for exactly the workflow Elevance and other multi-state payers are converging on — running conversational member research at scale, with AI follow-up that adapts to what each member just said, rather than flattening them into a dropdown.

For a BCBS-federation carrier, that means:

• One research surface, many state contexts. A single Perspective AI study can ask the right follow-up question for a California PPO member, an Indiana Medicaid member, and a Virginia Medicare Advantage member — without three parallel form versions.
• Depth on the moments forms miss. The "I'm not sure," "it depends," and "I almost switched plans last year" answers — the ones that drive renewal, satisfaction, and Star Ratings — surface in a conversation, not a checkbox.
• Compounding member context. Every conversation enriches the next research question, the next network decision, the next member-comms touchpoint. We've written about this continuous-discovery loop in the 2026 continuous discovery report and the 2026 voice of customer report.

Multi-state payer research teams typically use Perspective AI alongside the Interviewer agent for outbound member studies and Intelligent Intake for inbound member-facing conversational surfaces. Teams that have replaced enterprise-CXM survey programs with conversational research have written about the ROI in the 2026 conversational AI ROI report.

Frequently Asked Questions#

What is Elevance Health?#

Elevance Health is the publicly traded parent company of Anthem Blue Cross Blue Shield, formed when Anthem, Inc. rebranded in June 2022. The company is one of the four largest U.S. health insurers, serving roughly 47 million medical members across 14 BCBS-licensed states and operating the Carelon health services platform (behavioral health, pharmacy, analytics, global services) as a separate growth engine alongside its insurance business.

How many states does Anthem Blue Cross Blue Shield cover?#

Anthem Blue Cross Blue Shield holds BCBS licenses in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Each state plan operates under its own regulators, Medicaid rules, and network requirements, which is why multi-state intake and member-experience design is structurally harder for Elevance than for a single-state carrier.

What is Carelon?#

Carelon is Elevance Health's separately branded health services platform, including Carelon Behavioral Health (mental health and substance-use services), CarelonRx (pharmacy benefit manager), Carelon Insights (analytics and payment integrity), and Carelon Global Solutions (operations infrastructure). Carelon is Elevance's bet that the next decade of growth comes from services attached to claims rather than the claims themselves — the same playbook UnitedHealth runs with Optum and CVS Health runs with Caremark.

How does conversational AI help multi-state health insurers?#

Conversational AI helps multi-state health insurers by dynamically branching on state-specific eligibility rules, network adequacy requirements, and benefit designs without forcing members through a one-size-fits-all form. A single conversational agent can ask a California PPO member, an Indiana Medicaid member, and a Virginia Medicare Advantage member the right next question for their plan, replacing the choice between a flattened lowest-common-denominator form and 14 parallel intake stacks.

What is the Sydney Health app?#

Sydney Health is Anthem's member experience mobile app, used to find in-network care, check claims, access digital ID cards, and engage virtual primary-care visits. Elevance has progressively added AI-assisted features — symptom checking, virtual-care triage, care-navigation prompts — moving Sydney from a transactional lookup tool toward a continuous, conversational member-engagement surface.

Is Anthem the same as Blue Cross Blue Shield?#

Anthem is one of 33 independent Blue Cross Blue Shield licensees that together form the BCBS federation, not a synonym for BCBS itself. Anthem is the largest single BCBS licensee — operating in 14 states under the Anthem Blue Cross or Anthem Blue Cross Blue Shield name — but other Blues plans (Highmark, BCBS Michigan, Health Care Service Corporation, Florida Blue, and many others) operate independently in the remaining states.

Conclusion#

Elevance Health's AI strategy is shaped less by which models it picks and more by the structural problem it has to solve: 14 different state-licensed BCBS plans, each with its own regulatory and member context, sitting under a single Anthem Blue Cross brand and a single $171B P&L. Static intake forms are architecturally wrong for that problem — they either flatten members into a lowest-common-denominator schema or fragment the experience across 14 parallel stacks. Conversational AI insurance experiences are architecturally right, because they branch on context and let members speak in their own words. Carelon, Sydney, Concierge Care, and the GenAI underwriting investments are all moves along the same direction of travel.

For multi-state payer research, product, and CX teams looking to run conversational member research at the depth that BCBS-federation complexity requires, Perspective AI is built exactly for this workload — start a research study, browse use cases, or compare alternatives to see how a conversational layer replaces the multi-state form problem at the root.