Dive Brief:
- More than 150 providers and digital health companies have been approved to participate in the CMS’ new payment experiment that aims to expand access to technology-backed care for chronic conditions.
- Under the Advancing Chronic Care with Effective, Scalable Solutions Model, first announced in December, participants will receive set reimbursement for managing Medicare beneficiaries’ chronic conditions, like diabetes, chronic kidney disease, hypertension, anxiety and depression.
- Participating companies include weight management company Noom, Alphabet-backed life science company Verily and wearable maker Whoop. Companies interested in participating when the model launches this summer have until May 15 to apply.
Dive Insight:
The Center for Medicare and Medicaid Innovation’s ACCESS Model will run for 10 years starting in early July, allowing participating organizations to earn recurring monthly payments for using digital health technologies to manage certain chronic conditions.
However, full payment under the model is based on health outcomes. For example, participating digital health companies and providers would need to help a patient with hypertension lower their blood pressure by a set level to earn full reimbursement, according to the CMS.
The proposed payment rates to companies are “modest” at around $7.50 to $35 per beneficiary per month, depending on the clinical track, according to a March report by law firm Foley Hoag.
Most companies that have received provisional approval to participate in the model have not previously served Medicare beneficiaries. Before participating in the model, the companies will need to complete a number of requirements, including enrolling in the Medicare program if needed, the CMS said.
More companies can still apply to participate when the model launches, and applications received after the May deadline could be considered for a Jan. 1 start date, the agency added.
The model is a big deal for digital health firms, which have long said that inconsistent reimbursement from payers challenges uptake of their tools. ACCESS also tackles chronic care, a priority area for the HHS under Secretary Robert F. Kennedy Jr., who has said he wants to fight chronic conditions by reforming food and health systems.
