You know you need to modernize your Medicare Advantage operations. You’ve known for months. But the same questions stall every decision: What if implementation disrupts operations? What if data is lost? What if the system underdelivers? How do you justify the risk when current tools technically still work?
So you wait. Another quarter. Another patch. Another workaround. You’re running in place, expending energy and budget just to stay where you are.
And while you weigh the cost of switching, one thing goes unmeasured: the cost of waiting.
Two Paths: Where You’ll Be in 18 Months
The path you choose today determines where your organization will be 18 months from now. More importantly, it shapes the conversation you’ll be having with your board about the state of your operations, your competitive position, and the decisions that got you there.
Path 1: Continue Paying the Tax You’re Already Paying
18 months from now, you’re still managing the same workarounds, the same manual processes, the same integration headaches. And the tax compounds:
$2 million in CMS penalties for a technology failure. One plan’s cost for failing to track out-of-pocket spending. Not a policy failure. A system failure.
$25 million in lost federal revenue when Star Rating drops from 4.0 to 3.5 because your operational systems can’t support the metrics CMS measures. That’s 5% of revenue for a $500M plan. The board wants to know why you didn’t see this coming.
80% of your IT budget consumed by maintaining legacy systems instead of building strategic capabilities. You’re running in place—spending more each year while falling further behind. Every budget meeting becomes a defense of why IT costs keep rising while capabilities lag. Every dollar spent keeping old systems alive is a dollar not invested in competitive advantage.
11-12 percentage points lower in member satisfaction and caller effort scores compared to plans with integrated systems. Your members feel the friction. Your staff feels the frustration. Your competitors are pulling ahead.
The Reality: While costs increase and capabilities stagnate, the market keeps moving forward.
Path 2: Modernize Your Operational Infrastructure
18 months from now, you’re operating on an integrated platform where enrollment updates flow automatically to billing, reconciliation happens in real-time, and your team focuses on member engagement instead of data entry.
Star Ratings Improve. Call satisfaction rates approach 90% (up from 79%). Resolution rates exceed 89% consistently. Your Star Ratings increase, protecting your federal revenue.
Compliance Is Automated. When CMS announces new requirements, your platform updates automatically. You’re presenting to the board about proactive compliance, not reactive damage control.
IT Overhead Decreases. Your IT team focuses on strategic capabilities that drive competitive advantage. Your technology budget shifts from “keeping the lights on” to “building the future.”
Competitive Position Strengthens. You’re achieving 99.5% auto-processed enrollments with automatic billing updates. You configure new benefits in days. You’re winning RFPs. You’re not just keeping pace. You’re pulling ahead.
You’re pulling ahead.
Member Experience Improves. Your NPS scores reach 50.73%, well above industry targets of 37. Member satisfaction increases. Retention improves. Acquisition costs decrease.
The Reality: You’re not just surviving. You’re building the operational foundation for sustained competitive advantage. And you’re the one who made it happen.
What Happens Next Depends on Your Path
Here’s what modern implementation actually looks like with Miramar:Member. The fear is often worse than the reality.
Timeline: 7-9 months from contract to go-live
Your Team’s Effort: Approximately 420 hours total across the entire implementation
Risk Mitigation: Legacy and new systems operate in parallel before cutover, with a pre-defined rollback plan and 30-90 days of embedded post-go-live support
This isn’t experimental. It’s a proven framework that balances speed, risk mitigation, and operational continuity.
Get a complete view of modern Medicare Advantage operations in our Buyer FAQ. Find answers to common questions about implementation, integration, and compliance with Miramar:Member.
If You’re Staying With Legacy Systems (For Now):
You need a survival strategy. Download our critical watchlist with specific operational, compliance, and financial metrics to monitor quarterly. If these numbers trend in the wrong direction, the cost of staying has exceeded the cost of switching.
You Don’t Have to Make This Decision Alone
The choice between these two paths isn’t easy. The risks feel real. The questions are legitimate. And the stakes are high.
At Convey, we’ve helped Medicare Advantage plans work through exactly these questions. We understand the barriers that make modernization feel risky. And we’ve built proven frameworks to address them.
Whether you’re ready to transform or need to understand what staying looks like, we can help you make the right decision for your organization.
