The Centers for Medicare and Medicaid Services has announced a provisional list of 150 companies that will participate in an experimental model of care that seeks to bring down the cost of chronic disease management.
The Advancing Chronic Care with Effective, Scalable Solutions model pays for tech-enabled care that improves the health of Medicare patients with high blood pressure, diabetes, chronic musculoskeletal pain, and depression. It will start the first week of July.
As suspected, the program will be dominated by integrated tech platforms that administer care like Cadence, Doctronic, Headspace, and Noom. There are also a mix of medical groups and tech companies, some of which will have to partner in order to participate. Story Health Partners, an agentic company that supports specialty care, which was acquired by data analytics company Innovaccer last year, is one such.
Any surprises?
The biggest surprise is the sheer number of participants—and that CMS is seeking even more. The agency said that it will keep accepting applications until May 15.
As we noted in February, the reimbursement rates for this program are fairly low. And participants must show that they can positively impact patient health outcomes before they can collect on their full reimbursement—a fairly high risk prospect.
Notably, Hinge and Sword health, both large musculoskeletal pain platforms, are not listed among the participants.That’s not surprising as this program favors companies that are software, versus care delivery services that are augmented by technology. Neither is Oura Ring, though Whoop is. Apple is also not listed, which stood out to us.
Still, companies seem eager to take the risk, especially as the government administrators have noted that industry is encouraged to give feedback. The part of CMS that launched the program – The CMS Innovation Center – is a testbed for innovative ideas that aim to move healthcare to payment based on outcomes, versus services rendered.
“Money is tight, the numbers are really tight,” said Lisa Bari, who leads policy and partnerships at Innovaccer, a health data company that sells to health systems. Still, she says that for companies who believe they can drive positive health outcomes there’s a financial opportunity here and possibly one for health systems that partner with technology vendors
“I’m going to help you drive the total cost of care down,” she said. “My incentives are aligned.”
The reimbursement rates put health systems in a tough place, because it doesn’t make sense for them to try and deliver the care and outcomes for the price on offer. But through partnering, health systems can refer patients they think would do well in an AI-driven chronic care program, potentially lowering the cost of that patient’s care while also keeping them in the system.
The companies that participate in ACCESS are going to start marketing heavily to Medicare patients, Bari says, and health systems can either wait for their patients to get picked off or they can proactively partner with and refer patients to a company like Story.
“You should be proactive if you want the data to be shared back with you,” she said.
Bottom line: A lot of companies are on board, many more than we expected. Many of the top officials from this administration (Jacob Shiff, Abe Sutton, Chris Klomp) are former entrepreneurs and operators themselves, and they’re tightly networked with many of the leading digital health companies. Those that have raised their hands to participate are demonstrating publicly that they have AI chops and tight relationships with health systems, because the program would be a non-starter without that.
Here’s the full list of companies that are participating in the ACCESS program: