Buyer-weighted study finds benefits confusion, outreach failure, and fragmented payer workflows, not eligibility processing alone, are driving the greatest first-120-day transition risk; 20% of surveyed payer users report attending RISE National in Orlando this week
ORLANDO, FL / ACCESS Newswire / March 23, 2026 / Black Book Research today announced the release of The Medicaid-to-Medicare Transition Tech Stack, a new report in its 2026 Payer IT Software and Services Series examining how health plans manage one of the most operationally fragile moments in the member journey: the transition from Medicaid into Medicare. Based on payer-user feedback collected from Q4 2025 through Q1 2026, the study evaluates where transitions fail, which technologies matter most, how much manual intervention remains, and what payer organizations must prioritize in 2026 to improve continuity, engagement, and operational efficiency.
The report was designed to answer key questions facing payer executives, including where the Medicaid-to-Medicare handoff breaks down most often, which technology capabilities have the greatest impact in the first 90 to 120 days, which member outcomes are hardest to stabilize, where plans are overinvesting or underdeveloped, and what changes are most likely to improve retention, provider alignment, and member experience.
Twenty percent of surveyed payer users also reported they are attending RISE National in Orlando this week, underscoring the relevance of the findings for Medicare Advantage, D-SNP, Stars, interoperability, quality, and member engagement leaders gathered there.
"Black Book's 2026 payer-user findings make clear that Medicaid-to-Medicare transition failures are no longer rooted primarily in enrollment mechanics. They are rooted in fragmented payer IT architecture," said Douglas Brown, President of Black Book Research. "When engagement platforms, interoperability layers, care management workflows, provider-facing systems, and operational handoff processes are disconnected, plans default to manual rescue mode. The organizations outperforming in this study are the ones operationalizing a unified transition tech stack that activates members faster, preserves provider continuity, improves data liquidity across teams, and reduces preventable abrasion during the first 120 days."
Among the most significant findings, 26% of respondents identified benefits explanation and member understanding as the greatest avoidable source of transition friction, followed by member outreach failure at 21% and PCP and network continuity at 17%. When asked which capability has the greatest impact on transition success, respondents ranked omnichannel member engagement first at 24%, followed by interoperability and unified data exchange at 22%. The study also found that manual workarounds remain pervasive, with 19% of organizations saying they always rely on them and 37% saying they do so often. Only 7% of respondents described their current transition model as fully integrated and proactive.
Black Book also found that the hardest outcomes to stabilize in the first 90 days are member understanding of benefits and coverage at 25%, successful contact and engagement at 21%, PCP continuity at 16%, and medication continuity at 14%. Respondents said plans are overinvesting in reporting/dashboard point solutions at 23% and enrollment workflow tools at 20%, while underdeveloping cross-program member journey orchestration at 23% and real-time data exchange across payer, provider, and outreach teams at 21%. Looking ahead, the top priorities for 2026 were trigger-based outreach tied to eligibility and care events at 26%, better benefits education and onboarding journeys at 22%, and a unified member record across Medicaid and Medicare operations at 19%.
The report includes a payer-user appendix ranking vendors evaluated within live transition-related environments. Vendors named in the report include Availity, Cotiviti, Edifecs, InterSystems, Innovaccer, HealthEdge Wellframe, Datavant, Icario, mPulse, Zipari, Advantmed, Reveleer, Onyx, Arcadia, Conduent, Inovaare, ZeOmega, Signify Health, Vim, and Wolters Kluwer Health Language, reflecting payer-side assessments of operational usefulness, workflow fit, implementation performance, and strategic value in transition management.
The vendor evaluation framework is based on payer-centered KPIs focused on execution rather than feature breadth alone. Black Book's scoring considered measures such as ease of implementation, speed to first measurable value, integration with existing payer systems, usability for operations teams, workflow fit, configurability, data accuracy, interoperability, member engagement effectiveness, provider collaboration support, reduction of manual workarounds, reporting transparency, compliance readiness, client support responsiveness, and overall strategic value in managing the Medicaid-to-Medicare transition.
The Medicaid-to-Medicare Transition Tech Stack is now available from Black Book Research as part of its 2026 Payer IT Series for industry stakeholders at https://www.blackbookmarketresearch.com
About Black Book Research
Black Book Research is an independent, vendor-agnostic healthcare technology and services market research firm focused on payer operations, healthcare IT, digital health, interoperability, and healthcare services. Its research is designed to help healthcare organizations evaluate operational performance, workflow fit, implementation risk, and measurable outcomes in rapidly evolving markets. Black Book has been surveying IT user satisfaction in the Payer & Health Insurers since 2003. Media contact Kat Johnson at research@blackbookmarketresearch.com
SOURCE: Black Book Research
View the original press release on ACCESS Newswire:
https://www.accessnewswire.com/newsroom/en/healthcare-and-pharmaceutical/black-book-research-releases-new-2026-payer-it-series-report-on-the-m-1150581
