Medicare to test new ACCESS payments that can cover AI care

In short: Medicare is launching a new 10-year test program that pays healthcare groups for patient results, which can make it easier to pay for AI that supports people between doctor visits.

What happened

The Centers for Medicare and Medicaid Services, which runs Medicare, is starting a program called ACCESS on July 5. ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. It will run for 10 years and includes 150 participating organizations.

ACCESS changes how payments work. Traditional Medicare often pays based on time a clinician spends with a patient. ACCESS instead aims to reward outcomes, like lower blood pressure or reduced pain, rather than a checklist of activities.

The program covers several long-term conditions, including diabetes, high blood pressure, chronic kidney disease, obesity, depression, and anxiety. One participant is Pair Team, a healthcare company that works with people who have chronic conditions and also face challenges like unstable housing, food insecurity, or transportation problems.

A key point is that Medicare has not had a clear way to pay for an AI agent, meaning software that can talk and act on tasks like a helper, that monitors patients between visits, calls to check in, coordinates referrals, or reminds someone to pick up medication. ACCESS creates a payment pathway for that kind of ongoing support.

Why it matters

For patients, the biggest change could be more help outside the doctor’s office, like follow-up calls and support staying on track with care (similar to having a case manager who is available more often). For taxpayers and patients, there are also concerns to watch, including how sensitive health data is handled and whether these Medicare experiments ultimately save money or add costs.

Source: TechCrunch AI