CMS has unveiled its new ACCESS Model—an ambitious 10-year initiative aimed at expanding digital, tech-enabled care for millions of Medicare beneficiaries. In this discussion, Laura O’Toole, CEO of SureTest, joins Bill Russell and Sarah Richardson from This Week Health to unpack how outcome-based reimbursement could finally accelerate innovation in remote monitoring and chronic disease management. They explore what this shift means for CIOs, including the need for stronger data interoperability, integrated analytics, and secure pipelines to support continuous digital care. The conversation also highlights risks, from digital literacy gaps to patient privacy concerns as de-identified data gains value across the industry. From wearables and home health devices to the challenge of building a true digital front door, this episode examines how ACCESS could reshape care-in-place models—and why commercial payers may soon follow Medicare’s lead.
Key Points: CMS Access Model
- Overview
- CMS Innovation Center launched the “Access” model to expand digital care for Medicare patients.
- Focuses on chronic care for conditions like obesity, diabetes, musculoskeletal pain, and depression.
- Aims to shift from fee-for-service to outcome-based reimbursement.
- The program will run for 10 years starting July 1, 2026.
- Key Features:
- Introduces a results-focused payment model.
- Provides clinicians with predictable payment options and flexibility to use digital tools.
- Focuses on four clinical tracks:
- Early cardio-kidney metabolic conditions (e.g., hypertension, obesity, pre-diabetes).
- Cardio-kidney metabolic conditions (e.g., diabetes, chronic kidney disease).
- Musculoskeletal conditions.
- Behavioral health conditions (e.g., depression, anxiety).
- Potential Benefits:
- Promotes holistic care, including behavioral health, lifestyle coaching, and social needs.
- Encourages patient engagement through a “single digital front door” for care management.
- Could reduce hospitalizations and emergency room visits, saving significant healthcare costs.
- Privacy and Data Concerns
- Discussion on the use of de-identified patient data for research and innovation.
- Concerns about whether individuals should benefit financially from the use of their data.
- Importance of transparency and trust in how data is used to improve outcomes.
Resources
- ACCESS: What this new payment model means for physicians and patients
- CMS unveils ACCESS model to expand digital care for Medicare patients
- CMMI debuts ACCESS Model to spur use of tech in chronic disease treatment