The Centers for Medicare and Medicaid Services (CMS) is expanding its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) pilot program to fund the use of digital technologies in chronic disease management. Beginning next spring, the program will add dedicated pathways for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and smoking cessation programs, along with longer support for musculoskeletal conditions after the initial 12-month care period.
ACCESS was launched just two months ago and is expected to continue for 10 years. The program currently covers cardiometabolic, musculoskeletal, and behavioral health-related conditions. Jacob Shiff, CMS’s chief artificial intelligence and technology officer, said during a presentation on Tuesday that the current and expanded pathways will include conditions affecting roughly three-quarters of people enrolled in Medicare.
Outcome-Linked Care Payments
ACCESS allows participating healthcare organizations to receive monthly payments for using digital technologies to manage chronic conditions, with payments tied to patient outcomes. According to CMS, more than 160 companies have enrolled in the program, most of which have not previously worked with Medicare beneficiaries.
The participants include smaller telehealth providers, meditation app Headspace, an AI-powered chatbot tool from Welldoc, and a medical services group founded by wearable-device company Whoop.
A Parallel Pathway with the Food and Drug Administration
Associated with the program is a pathway through the U.S. Food and Drug Administration (FDA) that allows certain digital health devices and technologies not approved by the agency to collect real-world use data through ACCESS. Four participants have so far been selected for this pathway, which is called Technology-Enabled Meaningful Patient Outcomes (TEMPO).
The selected organizations include behavioral health company SonderMind, Limbic, which is developing an AI voice agent for therapy, Cadence Solutions, which is developing a tool to support hypertension management, and continuous blood glucose monitoring device company Dexcom. Some of these companies are also participating in ACCESS.
What Is Changing in Practice?
The move expands the range of conditions that can benefit from a government payment model based on care outcomes, while also linking CMS’s payment experiment with the collection of real-world evidence through the FDA. CMS Administrator Dr. Mehmet Oz said the two pathways allow technologies to move more quickly through CMS and FDA procedures instead of navigating separate government pathways.
However, ACCESS remains limited to traditional Medicare. CMS said organizations that administer Medicare Advantage and Medicaid, as well as private health insurance plans, have agreed to adopt a payment structure compatible with the program, including Blue Shield of California, Cigna, CVS Health, and UnitedHealthcare. This does not mean that these organizations have automatically joined the program itself; rather, it indicates the adoption of a similar payment structure, according to the announcement.