Health tech company Cadence said Monday it will be among the first to participate in an experimental Medicare program that will pay providers set amounts to manage their patients’ chronic conditions — and only pay them full price if their patients’ conditions improve by certain margins. The model is meant as an alternative to paying for individual services.
Announced in December by the Center for Medicare and Medicaid Innovation, the program, called ACCESS, generated excitement among policy experts and health tech executives who believed the initiative — designed to expand access to technology-supported care — might incentivize the adoption of new tools in service of better health outcomes at lower costs. The enthusiasm was tempered, however, in February when CMMI revealed payment rates that came in lower than some expected.
ACCESS participants will be able to earn between $180 and $420 per patient the first year, depending on the exact condition treated. The full amount will be paid only if a provider’s patients reach the desired outcomes. That’s far less than a provider could earn for billing remote physiologic monitoring or chronic care management codes. For example, under a common remote patient monitoring, or RPM, model, a provider could earn about $100 per month. At the time, experts told STAT that to participate in ACCESS, providers would need to make heavy use of artificial intelligence to reduce the amount of expensive human labor required to successfully manage a patient’s care.
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