Medicare’s new payment model is built for AI, and most of the tech world has no idea

Medicare has launched ACCESS, a groundbreaking 10-year program designed to integrate AI into healthcare. This new payment model rewards health outcomes rather than traditional activities, creating a pathway for AI-driven medical care at a federal scale. The program, which goes live on July 5, aims to revolutionize how chronic conditions are managed.

Pair Team, a company focused on serving underserved populations with chronic conditions, is among the 150 participants in the ACCESS program. They have developed an AI voice agent named Flora that serves as the primary patient interface, handling intake, referrals, and check-ins. This technology allows for continuous patient engagement and support, especially for those facing challenges like unstable housing or food insecurity.

The ACCESS model covers conditions such as diabetes, hypertension, and depression, and provides predictable payments to participating organizations. The full payment is earned only when patients achieve measurable health goals. This contrasts with traditional Medicare, which reimburses based on time spent with a clinician, offering no mechanism to pay for AI-driven monitoring between visits.

While promising, the program faces challenges including financial risks and concerns about patient data privacy. CMS is paying less per patient than anticipated, making it crucial for organizations to automate patient interactions to be viable. Nevertheless, ACCESS represents a significant step towards a more outcome-focused and technologically advanced healthcare system.