Medicare Advantage plans are facing one of the most financially challenging environments in recent memory. At the SSN Medicare Advantage Strategy Summit in Arlington, Virginia, one message surfaced repeatedly: growth alone is no longer enough.
Michael Bagel, Vice President of Public Policy at the Alliance of Community Health Plans, set the tone early: the market has moved from “Membership over Margin” to “Margin Prioritized.” That framing stayed with me throughout the entire event.
As a core solutions specialist at Convey Health Solutions, this is the landscape I navigate every day alongside our health plan clients. What the summit reinforced is that disconnected systems and siloed teams have become a financial liability, and plans that fail to address them will feel the consequences.
Over 70% of MA plans are at a breakeven or below
Jonathan Cho, VP of Medicare Product, Strategy, and Execution at Healthfirst, shared a number that stopped the room: more than 70% of MA plans operate at breakeven or below. The PMPM squeeze ranges from $10 to $100, driven by regulatory change, rising utilization costs, and a switch rate that hit an all-time high of 21% in 2026. The collapse of Vermont’s MA market stands as the clearest signal of what happens when scale and margin fall out of alignment.
Siloed teams are a compliance and retention risk
Gretchen Wagner, Associate Vice President of Risk Management at Humana, put it plainly: “You HAVE to bring your various teams together. IT, compliance, operations, everyone.” Her advice to the C-suite was equally direct: invest in technology that is agile, compliant, and built to evolve with regulations.
A conversation during a breakout session brought this to life: a change management professional from a regional health plan described how her team manually pieces together data from disconnected systems to produce reports that appear seamless to leadership, even though the process behind them is highly manual and time-consuming. That gap between what leadership sees and what operations actually endures is a problem many plans are still carrying.
Member retention starts with getting the fundamentals right
Janine V. Angel, Senior Director of Medicare Strategic Business Operations and Compliance at Centene, reminded the room that the member remains the constant amid all the change. Her data made the retention stakes concrete: 25 to 40 percent of members who lose their primary care physician will switch plans, and 15 to 30 percent of those who file grievances will do the same. With switch rates at record highs, getting the fundamentals right is a strategic priority.
What comes next: Convey’s live solution demos
Lori Rund, Vice President of Medicare Advantage at Johns Hopkins Health Plans, closed the loop on what plans need to do: stop operating in silos, rally teams around a shared purpose, and bring in new capabilities even when the timeline feels long. “We need to be able to build our systems in order to be ready to respond,” she said.
The challenges discussed throughout the summit won’t be solved by any one team. They require better coordination, better technology, and better visibility. These are exactly the conversations happening in Convey’s Live Healthcare Solution Series, my weekly series of 30-minute live demos across enrollment, compliance, reconciliation, and member operations. If the summit resonated with you, the demo series is a good next step.
