The Centers for Medicare and Medicaid Services has selected 150 digital health companies and providers to participate in the launch of a technology-enabled chronic care model.
In December, the Center for Medicare and Medicaid Innovation (CMMI) announced the Advancing Chronic Care through Effective and Scalable Solutions (ACCESS) model, a 10-year payment program to accelerate the use of technology to treat chronic conditions. CMS aims for the ACCESS model to provide stable and recurring payments for technologies used to treat diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. This model helps pay for telemedicine software, wearables, and wellness apps that address the situation.
CMMI plans to use outcome-based payments to cover technology costs for Medicare providers when patients with eligible chronic conditions achieve clinically important outcomes, such as lower blood pressure.
The model will begin on July 5 and run until June 30, 2036.
CMS also announced Monday that it is extending the original application deadline until May 15. Applications can be made from the participant portal.
CMS said in a press release that of the 150 organizations selected, most have never previously served Medicare beneficiaries. These organizations “will provide additional technology-enabled care options to help people manage chronic conditions such as high blood pressure, diabetes, chronic pain, and depression,” CMS said.
CMS says organizations participating in the ACCESS model must adhere to strict guardrails, including Medicare Part B enrollment as a provider or supplier, licensing compliance, data privacy and security standards, results reporting and other quality standards.
Commercial payers, representing 165 million members across Medicare Advantage, Medicaid, and commercial insurance, also agreed to follow the ACCESS model payment approach. Payers that have signed the pledge include Blue Cross and Blue Shield of Arkansas, Blue Shield of California, Blue Cross and Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, Blue Cross Blue Shield of Tennessee, CareFirst Blue Cross Blue Shield, Centene, Cigna, CVS Health, Devoted Health, Guidewell, Horizon Blue Cross Blue Shield of New Jersey, Humana and United Healthcare.
These commercial payers have agreed to make arrangements with providers that provide consistent performance-based payments for the use of medical technology. The plan also agreed to collaborate with primary care and referral providers, a hallmark of the CMMI ACCESS model.
The 150 participants selected by CMS include a variety of technology-enabled healthcare companies. The list includes AI doctor startup Doctronic, virtual nutrition therapy provider Berry Street, healthy aging startup Bold, mobile health service provider DocGo, remote monitoring company Withings, healthcare navigation app Castlight, virtual medical specialty clinic Cecelia Health, virtual mental health company Headspace, and hybrid mental health provider Sondermind.
Health tech company Verily is among the 150 participants, along with weight loss companies Noom and Weight Watchers, brain health platform Isaac Health, and telemedicine provider HealthTap.
Value-based care enablement companies Guidehealth and Aledade were also selected.
Specialty medical institutions and kidney care providers, including NY Kidney Hypertension Medicine, have also signed on to participate. Devoted Medical is the in-house medical group of Devoted Health, a Medicare Advantage insurance startup. CareHarmony, a chronic care management company. Mariposa Regional Health Center; Cardiovascular Specialists in Orlando, to name a few.
The ACCESS model targets four clinical areas that collectively represent chronic conditions that affect more than two-thirds of Medicare beneficiaries. The four categories are early cardiorenal metabolic (eCKM) conditions, including hypertension, dyslipidemia, obesity, overweight with markers of central obesity, and prediabetes. CKM conditions include diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease. Musculoskeletal (MSK) conditions. Behavioral health conditions such as depression and anxiety.
However, the payment rates (PDF) for the ACCESS model announced in February were lower than industry expectations and below current billing models.
The annual allowance for the initial period, or first year, is $360 for eCKM, $420 for CKM, $180 for MSK, and $180 for behavioral health. The continuation rate that applies if the beneficiary continues in established care is exactly half that. $180 for eCKM, $210 for CKM, and $90 for behavioral health. MSK has no follow-on period.
Many digital health experts are scrutinizing this number and pointing out that clinician-led, high-touch chronic care may not be worth the effort.
According to a research note from strategy firm Capstone, redemption rates are lower than expected, putting model participants at risk of negative returns.
Capstone said the model could be a tailwind for scaling digital health companies like Omada Health and Hinge Health. Provider referral incentives and performance-based bonuses may increase beneficiary volume to offset margin pressures.
Omada Health and Hinge Health were not among the 150 approved applicants in the ACCESS model.
In December, the Food and Drug Administration also announced plans to select approximately 40 devices not yet cleared by the Food and Drug Administration at special authority discretion to participate in the ACCESS model.
