The Centers for Medicare & Medicaid Services chose 150 digital health companies and healthcare providers to participate in the launch of its technology-based chronic care model.
The Center for Medicare and Medicaid Innovation (CMMI) announced the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) model in December as a 10-year payment program to encourage the use of technology to treat chronic diseases. CMS aims for the ACCESS Model to provide stable, recurring payments for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety. The model will help pay for telehealth software, wearable devices and wellness apps that address these conditions.
CMMI plans to use outcomes-aligned payments to cover the cost of the technology for Medicare providers if a patient with a qualifying chronic condition achieves clinically significant outcomes, such as lowering their blood pressure.
The model will begin on July 5 and run until June 30, 2036.
CMS is also extending the initial application deadline to May 15, the agency said Monday. Applications can be submitted through participant portal.
among the 150 organizations selected, most have not previously served Medicare beneficiaries, CMS said in a news release. These organizations “will offer additional care options supported by technology to help people manage chronic conditions such as high blood pressure, diabetes, chronic pain, and depression,” CMS said.
Organizations participating in the ACCESS Model must comply with strict safeguards, including enrollment in Medicare Part B as providers or suppliers, licensing compliance, data privacy and security standards, outcomes reporting, and other quality standards, CMS said.
Commercial payers representing 165 million members in Medicare Advantage, Medicaid and commercial coverage also agreed to align with the ACCESS Model Payment Approach. Payers that signed the pledge include Arkansas Blue Cross and Blue Shield, Blue Shield of California, Blue Cross and Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Centene, Cigna, CVS Health, Devoted Health, Guidewell, Horizon Blue Cross Blue Shield of NJ, Humana and UnitedHealthcare.
These commercial payers have agreed to reach agreements with providers that will provide consistent, outcomes-aligned payments for the use of health technology. The plans also agreed to work with primary and referral care providers, a hallmark of the CMMI ACCESS model.
The 150 participants selected by CMS to participate include a variety of technology-enabled healthcare companies. The list includes AI doctor startup Doctronic, virtual nutritional therapy provider Berry Street, healthy aging startup Bold, mobile health services provider DocGo, remote monitoring company Withings, healthcare navigation app Castlight, specialty virtual medical practice Cecelia Health, virtual mental health company Headspace and Sondermind, a hybrid mental health provider.
Health technology company Verily is among the 150 participants, along with weight loss companies Noom and Weight Watchers, brain health platform Isaac Health and telehealth provider HealthTap.
Value-based care enablement companies Guidehealth and Aledade were also selected.
Specialty physician practices and kidney care providers also signed up to participate, such as NY Kidney Hypertension Medicine; Devoted Medical, which is the in-house medical group of Medicare Advantage insurance startup Devoted Health; CareHarmony, a chronic care management company; Mariposa Community Health Center; and Orlando Cardiac and Vascular Specialists, to name a few.
The ACCESS model focuses on four clinical areas that collectively represent chronic conditions that affect more than two-thirds of Medicare beneficiaries. The four categories are early cardio-kidney-metabolic (eCKM) conditions, which include hypertension, dyslipidemia, obesity, overweight with markers of central obesity, and prediabetes; CKM conditions, including diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease; musculoskeletal conditions (MSK); and behavioral health conditions such as depression and anxiety.
But he payment rates (PDF) for the ACCESS model, introduced in February, were lower than the industry expected and fell short of current billing models.
The annual amounts allowed for the initial period, or first year, are $360 for eCKM, $420 for CKM, $180 for MSK, and $180 for behavioral health. Follow-up period fees, applicable when a beneficiary continues established care, are exactly half: $180 for eCKM, $210 for CKM, and $90 for behavioral health. MSK does not have a follow-up period.
Many digital health experts have crunched the numbers and pointed out that high-level, physician-led chronic care may not be worth the effort.
Lower-than-expected reimbursement rates introduce the risk of negative profit margins for model participants, according to a research note from strategy firm Capstone.
Capstone said the model could represent a tailwind for large-scale digital health companies like Omada Health and Hinge Health. Supplier referral incentives and performance-based bonuses could boost beneficiary volume to offset pressure on margins.
Omada Health did not apply for the ACCESS Model, a company spokesperson said.
In December, the Food and Drug Administration also announced plans to select about 40 devices that have not yet been authorized by the agency to receive special agency discretion to participate in the ACCESS Model.
