Dive Brief:
- The Centers for Medicare & Medicaid Services (CMS) is set to introduce more chronic conditions into a new payment initiative within Medicare.
- This initiative, called the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model, will begin in spring 2027 and focus on conditions like heart failure, chronic obstructive pulmonary disease, substance use disorders, and tobacco cessation.
- Additionally, CMS will expand the payment duration for bone, joint, and mobility issues that lead to chronic pain, as announced on Tuesday.
Dive Insight:
The voluntary model began on July 5, featuring four initial chronic conditions: hypertension, diabetes, chronic musculoskeletal pain, and depression. Under this structure, organizations participating will receive ongoing payments for employing health technologies aimed at managing these chronic conditions. This aligns with HHS Secretary Robert F. Kennedy Jr.’s well-known objective to reduce chronic illness nationwide.
However, it’s important to note that participating entities will get the full payment only if Medicare enrollees meet specific health improvement targets. For instance, improvements in blood pressure or lipid levels would need to be showcased.
From the model’s start in July through December 31, 2027, participants can expect to earn between $180 and $420 during the first year of patient care. The initiative also includes payments for a subsequent “follow-on period,” which ranges from $90 to $210.
There are concerns from digital health companies regarding whether the payment rates are sufficient to support technology-driven care. Yet, despite these worries, over 150 healthcare providers and digital health firms have joined the initiative, among them Verily, an AI company under Alphabet, and the wearables company Whoop.
During a press conference on Tuesday, CMS Administrator Dr. Mehmet Oz expressed hopes that the impact of the ACCESS model would extend beyond just Medicare. He remarked, “As traditional Medicare launches this model — again, paying for outcomes, not for effort or process or some surrogate — you also open up the door for Medicare Advantage, for the Department of Veterans Affairs, for Medicaid patients, TRICARE patients.”
