New value-based payment model aims to boost tech use

The CMS Innovation Center is launching a new payment model to support the use of technology for chronic disease management, including telehealth services.

The agency, also known as CMMI, announced this week the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a voluntary, ten-year program starting in July. The ACCESS Model provides an "outcome-aligned payment approach" within Traditional Medicare to expand access to new technologies that help people manage chronic conditions, such as hypertension, diabetes, depression and chronic musculoskeletal pain.

The new outcome-aligned payments, known as OAPs in the ACCESS Model, will be recurring reimbursements made to providers for patients with qualifying conditions. The payments will be value-based, meaning the full reimbursement will be adjusted based on measurable health outcomes, such as a hypertensive patient lowering blood pressure by 10 mmHg. Each qualifying condition will have its own set of measurable outcomes affecting payment.

Primary care providers and referring clinicians will also be able to bill for a new co-management payment in the model for reviewing patient updates and associated coordination activities related to the ACCESS Model.

Providers are eligible to participate if they are enrolled in Part B. Those interested can apply starting Jan. 12. Applications are due by April 1.

CMMI stated that the new payment structure is designed to "complement traditional care" by providing clinicians with more flexibility to utilize technology-supported care options for chronically ill patients and rewarding results over a volume of activities.

Participating providers will be expected to offer "integrated, technology-supported care" across clinical consultations, lifestyle and behavioral support, therapy and counseling, patient education and care coordination, medication management and diagnostic testing. Participants will also be expected to order and monitor devices authorized by the Food and Drug Administration, including software.

The ACCESS Model also supports the use of telehealth services, including asynchronous virtual healthcare options.

The clinical tracks launching the model include cardio-kidney-metabolic conditions, such as diabetes, chronic kidney disease and heart disease, as well as early cardio-kidney-metabolic conditions, including hypertension, dyslipidemia and obesity. They also include musculoskeletal conditions and behavioral health conditions, including depression and anxiety.

Participants will receive payments based on the overall share of their organization's patients who meet outcome targets. This enables organizations to earn full OAPs even if some individual patients do not meet the defined outcomes.

The model will enable clinicians to utilize technology within care delivery to support chronically ill patients and prevent conditions in the first place, according to Accountable for Health (A4H), a nonprofit healthcare advocacy group.

"Provider organizations across the country have proven that when clinicians are given the tools, flexibility, and aligned incentives to focus on prevention and chronic disease management, patients experience better outcomes at lower costs," A4H said in a statement.

A4H's CEO Mara McDermott explained in a recent panel at Xtelligent's Payer + Provider Summit that aligned incentives are key to practices, particularly smaller practices, to get into value-based payment models.

"Because the lift to create the infrastructure to share information and upgrade systems is significant," she said. "Practices have overcome it now for years, but it's not nothing and it's not a one-time thing."

Federal policy needs to support incentives that enable practices to invest in new technologies and data exchange for care coordination, she added.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.