Medicare is launching the ACCESS payment model, a pilot program testing whether AI-driven health tech can lower costs while improving care. Over 150 healthcare organizations are participating, with payments tied to measurable patient outcomes rather than volume of services. The program targets chronic conditions affecting more than two-thirds of Medicare enrollees.
Medicare is officially launching its ACCESS payment model, a pilot program designed to test whether AI-heavy health tech companies can reduce medical costs while improving patient outcomes. Rather than paying providers for the volume of services delivered, Medicare will reimburse based on whether patients hit specific, measurable health targets — like lowering blood pressure in hypertensive patients. More than 150 healthcare organizations have signed on.
The model zeroes in on chronic conditions — high blood pressure, heart disease, diabetes, chronic pain, and depression — that collectively affect over two-thirds of Medicare enrollees. The payment rates are intentionally low (as little as $7.50 per patient per month), essentially pushing providers to lean heavily on automation and technology to make the economics work. Some major digital health players are sitting this one out, likely because their fee-for-service-oriented models can't generate sufficient cash flow under the new structure.
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Why it matters: If successful, ACCESS could reshape how the entire U.S. healthcare system pays for care — shifting from a volume-driven model to one rewarding real health improvements. With commercial insurers already pledging to follow Medicare's lead by 2028, the stakes extend well beyond this pilot.
