Dive Brief:
- CMS plans to add more chronic conditions to a new payment experiment in Medicare.
- Starting in spring 2027, the Advancing Chronic Care with Effective, Scalable Solutions, or ACCESS model, will launch tracks for heart failure, chronic obstructive pulmonary disease, substance use disorders, and tobacco cessation.
- CMS will also extend the payment period for bone, joint and mobility conditions that cause chronic pain, the agency announced Tuesday.
Dive Insight:
The 10-year voluntary model launched on July 5 with tracks for four chronic conditions: hypertension, diabetes, chronic musculoskeletal pain and depression.
Under the model, participating organizations will get recurring payments for using health technologies to manage chronic conditions. The model is consistent with HHS Secretary Robert F. Kennedy Jr.’s oft-cited goal of reducing chronic disease in America.
Still, participating companies will only receive full payment if Medicare enrollees achieve defined health outcomes. Enrollees would need to demonstrate improvements in blood pressure or lipids, for example.
From July 5 through Dec. 31, 2027, participants will receive between $180 and $420 for the first year of patient care. The tracks also include payments for a “follow-on period” that range between $90 to $210.
Digital health companies have expressed concerns that the model's payment rates aren’t enough to sustain technology-supported care. Despite concerns about the payment rates, more than 150 healthcare providers and digital health companies joined the model, including Alphabet-owned AI company Verily and wearables provider Whoop.
CMS Administrator Dr. Mehmet Oz said during a press conference Tuesday that he hoped the ACCESS model would have an impact beyond Medicare.
“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,” he said.
