Advance Notice 2027: Flat CMS Reimbursement, No Margin for Fragmentation

As Medicare Advantage organizations head into 2026, one reality is clear: reimbursement is effectively flat, while operational complexity continues to rise. Growth can no longer be “bought” through higher spend or absorbed inefficiency. Every dollar invested in member acquisition must work harder, and be measurable.

Yet most MA organizations still manage the front end of member acquisition through a patchwork of disconnected systems.

  • Marketing analytics live with agencies and social platforms.
  • Broker and call center activity resides in one or more CRMs.
  • Enrollment outcomes are often not reconciliation.

Plans are data-rich but short on truth. 

Applying the ERP Lens to Member Acquisition

In finance and supply chain, ERP systems exist to create a single, authoritative source of truth. The same discipline is now required at the front end of Medicare Advantage and this is where Cavulus product development has been focused. 

Member acquisition should be treated as a core operational function, not a collection of vendors and channels. That means aggregating marketing signals, broker performance, call center activity, permissions, scopes, and enrollment outcomes into one unified system of record; a true CRM, not just a sales tool.

Without this, organizations are left asking critical questions too late:

  • Which channels actually drive enrolled members?
  • Which brokers generate long-term retention versus short-term volume?
  • Where are dollars leaking due to poor follow-up, low conversion, or misaligned incentives?

Consumers willing to share data¹       ████████████████████ 82%

Consumers who feel understood²         ██████████           43%

Industry research shows consumers are broadly willing to share personal data for relevance, yet fewer than half feel organizations truly understand them, revealing an empathy gap driven by fragmented systems.

CRM Isn’t Just Control, It’s Empathy.

There’s another consequence of fragmentation that often goes unspoken: it erodes empathy.

When data is siloed, beneficiaries become transactions instead of people. Reps lack context. Organizations lose sight of the full journey, from first click or phone call to enrollment and beyond.

A true CRM enables understanding:

  • What prompted a beneficiary to reach out?
  • How many times have they engaged before enrolling?
  • Where confusion, friction, or hesitation occurred?

In a flat-rate environment, better relationships are good ethics and good economics.

The Year Ahead

CY2026 and beyond will reward organizations that treat member acquisition with the same rigor applied to finance, claims, and risk. Those that continue to operate through disconnected systems will find it increasingly difficult to control costs, explain outcomes, or scale responsibly.

The future of Medicare Advantage growth is cohesive data - unified, authoritative, and human.

1https://www.pwc.com/us/en/technology/alliances/library/adobe-personalization-and-trust-in-business.html
2https://www.deloittedigital.com/us/en/insights/research/personalizing-growth.html 

read More