Dugan Winkie, chief strategy officer at Cedar
Photo: Courtesy of Cedar
The Centers for Medicare and Medicaid Services is testing a voluntary model that ties provider payments to chronic disease management results gained through the use of partnering technology companies.
CMS on Monday announced 150 participants for the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model that is launching July 5.
Those that signed up include the tech companies, medical groups and specialty providers, such as for diabetes. CMS said that private payers, representing 165 million members across Medicare Advantage, Medicaid and commercial coverage, have also committed to aligning with the ACCESS Model's payment approach.
Dugan Winkie, chief strategy officer at Cedar, called the CMS Innovation Center model a "welcome step in the right direction."
Cedar is not among the companies that signed up for ACCESS but sees a trickle-down component to payment models in its work with patients on medical liability.
"With Medicare in particular, healthcare costs are still top of mind for them," Winkie said.
ACCESS is value-based care for Original Medicare, with the basis for better outcomes coming from tech companies and payment coming from CMS.
Other CMMI initiatives haven't always been embraced or gotten the desired results. CMMI in recent years has cancelled Primary Care First, End-Stage Renal Disease Treatment Choices and Making Care Primary.
In fact, GAO and the House Budget Committee have said that CMMI has only a 5.7% success rate on models. Since 2010, only four models of the 70 tested have been successfully implemented.
"The value-based care journey we've been on has not been a rocket success," Winkie admitted. "I think a large part of it is we haven't seen the cost come down by taking a more longitudinal view to patient health."
One big question for the ACCESS model is the reconciliation payment process in which a portion of payment is being withheld and reconciled by performance. The 12-month care process before reconciliation is paid is subject to two downward adjustments.
In better news, organizations are able to earn 100% of payment for their aligned beneficiaries if at least 50% of them meet the required measure targets.
"With rates widely viewed as lean, many are questioning whether traditional digital health players can make the economics work," Winkie said. "Tech could help be a connecting glue," he said, as it has insights into the patient journey.
AI could be a large part of the tech solution.
"I do believe AI as well as agentic AI will help on that front," Winkie said.
ACCESS has the component of doing more with less, embracing technology approaches rather than depending on legacy labor, all while keeping patient engagement and outcomes strong, Winkie said.
"The key thing I like about this is it's connecting care to outcomes over a period of time, versus episodic," he said. "The other big component is reimbursing new technology to help solve that problem."
Under the ACCESS model, participating providers can oversee patients using devices such as blood pressure monitors to help manage chronic conditions.
ACCESS expands access to technology-supported care for obesity, diabetes, musculoskeletal pain and depression patients who have Original Medicare. These conditions affect more than two-thirds of people with Medicare, CMS said.
Most of the organizations have not previously served Medicare beneficiaries, CMS said. Participating organizations must enroll in Medicare Part B, meet licensure, HIPAA and U.S. Food and Drug Administration requirements.
The application deadline has been extended to May 15.
Email the writer: SMorse@himss.org