I'm excited about CMS ACCESS

CMS ACCESS has be more excited than I've ever been about a payment program. Usually I stay in the innovation lane. But this is too juicy.

What if Apple, Google, WHOOP, Dexcom, Oura, Insulet, Tandem, ResMed, and Noom all entered a competition to see who could improve the well-being of as many Medicare beneficiaries as possible? What if they were explicitly allowed to advertise their technology to medicare beneficiaries, and anticipated that if they performed well, they’d get to market directly to broader populations? And what if CMS paid for this competition? 

That’s what ACCESS is. CMS’ ACCESS program gives technology companies access to medicare beneficiaries as direct customers, with the incentive of payments if - and only if - health outcomes are achieved. 

I am reading 100% focus on technologies, outcomes, and incentives, directly coupling the two. And I love it. 

Let’s review the CMS document together: 

First, tech in the title: “Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.” “Scalable” is a euphemism for tech and automation. 

Second, the payment amounts: $90-$420 per patient per year, for a given medical condition. This is NOT normal healthcare where an aspirin at the hospital costs $25/dose. The economics only work for Big Tech. 

Third, the focus on independence. These CPT codes and service types are not about clinic visits. They’re about technology on the body or at home, plus mental health and wellbeing diagnostics and care management. 

Fourth, the payment model is about outcomes. Never before have I seen such a direct incentive for a digital health company to optimize their technology for both clinically measured and patient-reported outcome measures. Usually there are so many barriers and so much friction between the actual patient outcome and the market price of a device. Now, it’s pretty darn direct. 

Fifth, the freedom to market this program. The companies participating in this are allowed to conduct outreach and awareness campaigns. This means that companies like Apple can directly contact users of its hardware and advertise to prospective customers. 

I don’t know about you, but my parents are both Medicare-eligible, have smartwatches, and actively use them for health management. I can’t wait for the day that Apple or other big tech companies are directly incentivised to help my parents become happier and healthier throughout the rest of their lives. 

~Shannon, the Optimistic Optimizer