Medicare is launching a major experiment to see whether paying digital health companies based on patient outcomes, rather than individual services, can improve care and lower costs. The Center for Medicare and Medicaid Innovation (CMMI) has provisionally approved more than 150 companies and providers to participate in the ACCESS model, an experimental program that represents a significant shift in how Medicare compensates technology-supported chronic care .

What Is Medicare's ACCESS Model and How Does It Work?

The ACCESS model, announced late last year by CMMI, takes a fundamentally different approach to paying for digital health services. Instead of reimbursing companies for each individual service or app subscription, Medicare will pay participants set rates to treat specific chronic conditions. The catch: payments are tied directly to measurable health outcomes . This outcome-based payment structure is designed to incentivize companies to actually improve patient health rather than simply deliver services.

The program focuses on treating a range of common chronic conditions that affect millions of Medicare beneficiaries. The conditions targeted include diabetes, hypertension, high cholesterol, musculoskeletal pain, anxiety, and depression . These are conditions that often require ongoing management and are ideal candidates for technology-supported care, such as wearable devices, health apps, and remote monitoring tools.

Which Types of Companies Are Participating in This Medicare Experiment?

The diversity of participants approved for the ACCESS model reveals the breadth of the digital health ecosystem. The 150+ companies include popular mental health apps, wearable device makers, a life sciences company tied to Google, and startups that help large health systems manage heart failure patients . This mix suggests that Medicare is willing to test payment models across multiple categories of digital health technology, from consumer-facing apps to enterprise software used by hospitals.

What's particularly notable is that most of these participants had not previously served Medicare patients before applying to ACCESS . This indicates that the program is opening doors for digital health companies that have traditionally focused on younger, commercially insured populations or direct-to-consumer markets. The modest payment rates and program restrictions did not discourage applications; in fact, the enthusiasm exceeded CMS officials' expectations .

How to Understand the Implications for Digital Health Companies

• Market Expansion: The ACCESS model creates a pathway for digital health companies to serve Medicare beneficiaries, a population of roughly 67 million people, without having to navigate traditional fee-for-service billing structures.
• Outcome Accountability: Companies participating in ACCESS must demonstrate that their technology actually improves health outcomes, shifting the burden of proof from simply delivering a service to proving clinical value.
• Payment Predictability: The set-rate payment model provides companies with more predictable revenue compared to variable fee-for-service models, though they must achieve measurable results to maintain participation.

The initial deadline for the first cohort of ACCESS participants was April 1, but CMMI announced it would extend the deadline to allow more companies to join . This extension signals that demand for participation in the program remains strong and that CMS sees value in expanding the pool of participants testing this new payment approach.

Why Does This Matter for Medicare Patients?

For Medicare beneficiaries, the ACCESS model could mean greater access to digital health tools and remote monitoring technologies that were previously unavailable or not covered. If the experiment succeeds in improving health outcomes while reducing costs, it could reshape how Medicare pays for chronic disease management across the board. The outcome-based payment structure also theoretically aligns the financial incentives of digital health companies with the actual health needs of patients, rather than incentivizing companies to maximize service volume.

The large number of applications to participate in ACCESS, which exceeded CMS officials' expectations, suggests that the digital health industry believes this payment model is viable and worth pursuing . Whether the experiment ultimately delivers on its promise to improve outcomes and reduce costs will likely influence how Medicare and other payers approach digital health reimbursement in the coming years.