Medicare expands payment model for technology-supported care

Medicare is expanding an outcomes-based payment model designed to make technology-supported chronic care part of mainstream healthcare delivery. From April 2027, the ACCESS Model will add heart failure, chronic obstructive pulmonary disease (COPD), substance use disorder and tobacco cessation to a programme that already covers several of the most common chronic conditions. The expansion is significant because ACCESS does not primarily reimburse the use of a particular app, device or digital service. Instead, the US Centers for Medicare & Medicaid Services (CMS) is testing whether providers can be paid for measurable improvements in patients’ health while using technology to deliver part of that care remotely.

The approach addresses one of the persistent barriers to scaling digital and hybrid care. Health systems increasingly have access to remote monitoring, virtual consultations, digital therapeutics and other technologies that can support patients outside traditional healthcare settings, but reimbursement structures have often developed more slowly than the technology itself. Successful pilots can therefore remain dependent on temporary innovation budgets or individual payment arrangements instead of becoming a structural part of healthcare delivery. ACCESS is designed to test whether changing the way care is paid for can help close that gap.

Paying for outcomes rather than technology

ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — started in July 2026 and is scheduled to run for ten years. The model operates within Original Medicare and creates a payment pathway for technology-supported care that complements the services patients already receive from their regular healthcare professionals. Its initial clinical areas include hypertension, obesity, prediabetes, diabetes, chronic kidney disease and cardiovascular disease, alongside chronic musculoskeletal pain, depression and anxiety.

From 1 April 2027, CMS will introduce additional tracks for heart failure, COPD, substance use disorder and tobacco cessation. These conditions broaden the model into areas where long-term monitoring, behavioural support and timely intervention can play an important role in preventing deterioration or unnecessary use of hospital care. Heart failure and COPD are particularly relevant examples because changes in a patient’s condition can develop between conventional appointments, creating opportunities for remote monitoring and earlier clinical intervention.

The payment mechanism is central to the experiment. Participating organisations are expected to use technology-supported approaches to achieve predefined health outcomes, rather than simply billing Medicare for supplying a technology or completing individual digital interactions. Patients remain connected to their existing healthcare professionals, while ACCESS providers are intended to complement rather than replace conventional care. CMS also requires participating organisations to share information with patients’ regular clinicians, making integration with the existing care pathway part of the model rather than treating digital care as a separate service.

Reimbursement remains a barrier to scale

Digital health has produced thousands of applications, monitoring platforms and virtual-care services, but technical availability has never guaranteed adoption. Healthcare organisations must determine how a new service fits into clinical workflows, who responds to incoming patient data, how responsibilities are divided between professionals and how the intervention will continue to be financed after an initial pilot or innovation programme ends. Without answers to those questions, even technologies with promising clinical evidence can struggle to progress from experimentation to routine care.

CMS explicitly identifies existing Medicare payment barriers as one reason beneficiaries have limited access to technology-supported chronic care. ACCESS therefore represents more than another digital-health demonstration project: it changes part of the financial infrastructure surrounding the technology. By connecting payment to outcomes, CMS is attempting to create room for providers to choose different combinations of technology, clinical support and patient engagement while remaining accountable for measurable results.

That does not mean technology-supported care will automatically prove cheaper or more effective. ACCESS is a long-term model, and participating providers will still have to demonstrate that their interventions produce the outcomes required by CMS. Different chronic conditions may also require very different combinations of technology and human care, while patient engagement, digital access and integration with existing providers will influence results. The expansion should therefore be viewed as a large-scale test of a different reimbursement model rather than evidence that digital chronic care has already solved these challenges.

Digital health enters mainstream healthcare financing

The wider significance is that the digital-health discussion is increasingly moving beyond whether individual technologies work. Health systems now have to decide how successful technologies become part of ordinary healthcare delivery, including who pays for them, how professionals are involved and which outcomes justify continued reimbursement. Those implementation questions are becoming particularly important as remote monitoring and hybrid care expand beyond individual disease programmes.

Although ACCESS is an American model, the underlying challenge is international. European healthcare systems are also trying to expand care at home, remote monitoring and digital treatment while facing workforce shortages, rising chronic disease and pressure on hospital capacity. Financing mechanisms frequently remain organised around traditional encounters and institutions even when healthcare delivery itself is becoming increasingly hybrid.

Medicare’s experiment is therefore worth watching beyond the United States. Technology can make it possible to monitor and support patients differently, but sustainable transformation requires healthcare systems to redesign the structures around that technology as well. By tying reimbursement to outcomes and integrating technology-supported services with existing clinical care, CMS is testing whether payment reform can become one of the mechanisms that finally moves digital health from promising pilots into routine healthcare.