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A new outcomes-based payment model in Medicare for managing chronic conditions has the potential to transform the way care is delivered in the home, according to new research
The Centers for Medicare and Medicare Services launched its ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) pilot model on Sunday, with more than 180 <a href="https://healthylife7.com/ut-southwestern-ranked-no-1-in-the-world-for-healthcare-research-by-nature-index/” title=”UT Southwestern ranked No. 1 in the world for healthcare research by Nature Index”>healthcare providers and digital health companies participating. While the first performance period has begun, organizations including home health agencies can still submit applications on a rolling basis to be considered for another cohort beginning Jan. 1, 2027.
The 10-year voluntary model tests an outcome-aligned payment approach in original Medicare to expand access to new technology-supported care options that help people prevent and manage chronic diseases, such as high blood pressure, diabetes, chronic musculoskeletal pain and depression
“There is now growing confidence across both the private and public sectors that certain technologies can deliver measurable improvements in health outcomes, reduce costs, and merit broader adoption at scale,” a new report about CMS’ ACCESS Model by the Peterson Center on Healthcare, a nonprofit organization focused on improving healthcare affordability in the United States, said. “The emergence of the ACCESS model signals even more definitively that the market is moving toward accountable, outcomes-focused payment for health technologies.”
It’s encouraging that CMS has created a new Medicare benefit for technology-based care that wasn’t previously covered in traditional Medicare, Caroline Pearson, executive director of the center, said
“I think this is an important modernization of the Medicare program,” Pearson told McKnight’s Home Care Daily Pulse in an interview Monday. “I also think it’s great to see the payments are tied to clinical meaningful improvements in outcomes.”
Home monitoring potential
Pearson said digital health technology, such as blood pressure monitoring and remote monitoring, can be particularly effective for home monitoring of chronic conditions
“This really does create a lot more opportunities for healthcare services that can be delivered outside of a doctor’s office,” Pearson said. “This enables providers to meet patients where they are and bring a lot more chronic disease support to their homes.”
“Many of these solutions have proven they can improve patient care and reduce costs,” she added. “I think home care providers can leverage these tools to improve their patients’ health and save money, and to do so in a technology-first approach that’s less dependent on human labor. This is a way to expand human capacity with digital tools.”
Pearson also thinks there are benefits of the ACCESS performance-based payment model over a fee-for-service model in evaluating the effectiveness of different technologies in improving clinical outcomes
“It’s a much better payment model for technology-based care,” she said
Health tech evaluation
Since 2023, the Peterson Health Technology Institute (PHTI), which was founded by the Peterson Center on Healthcare, has evaluated more than 60 health technologies to determine whether meaningful clinical improvement and net savings are achieved in practice. The Peterson Center report noted that ACCESS’s initial clinical tracks — behavioral health; musculoskeletal care; and cardio-kidney-metabolic conditions including diabetes, chronic kidney disease and hypertension — and associated outcome measures align closely with PHTI assessments.
“As outcome-based payment models are increasingly adopted, the market for health technologies will continue to evolve, including by producing more technologies that drive better clinical outcomes,” the report stated. “PHTI’s assessments have helped to lay the foundation for broader outcome-based payment models for health technologies; CMS’s ACCESS signals the readiness of the nation’s largest purchaser — Medicare — to do so at national scale.”
