Cadence to Test Medicare’s New Pay-for-Outcomes Model for Chronic Care

A health tech company, Cadence, announced Monday its participation in a novel Medicare program designed to shift chronic care management away from fee-for-service models and toward outcomes-based payments. The program, called ACCESS – Advancing Chronic Care Expansion through Systemic Strategies – will compensate providers based on improvements in patient health, rather than the volume of services delivered. This move signals a growing interest in leveraging technology to improve chronic disease care, but also highlights the financial challenges inherent in such transitions.

The ACCESS model, unveiled by the Center for Medicare and Medicaid Innovation (CMMI) in December, aims to expand access to technology-supported care and incentivize better health outcomes at a lower cost. The initiative generated initial enthusiasm among policy experts and health tech companies, with many believing it could spur wider adoption of digital health tools. However, that optimism was tempered in February when CMMI released the proposed payment rates, which were lower than anticipated by some in the industry. You can find details about the ACCESS program on the CMS website.

The Financial Equation for Chronic Care Innovation

Under ACCESS, participants can earn between $180 and $420 per patient in the first year, depending on the specific chronic condition being treated and whether patients achieve predetermined health improvements. This is significantly less than what providers currently receive for billing traditional remote physiologic monitoring (RPM) or chronic care management (CCM) codes. For instance, a provider utilizing a standard RPM model can earn approximately $100 per month per patient. This discrepancy led experts to suggest, in February, that successful participation in ACCESS would likely require substantial investment in artificial intelligence to reduce the labor costs associated with managing patient care effectively. STAT News reported on these concerns earlier this year, noting the necessitate for efficiency gains to make the program financially viable for providers.

The shift towards value-based care, where reimbursement is tied to patient outcomes, is not new. However, the ACCESS model represents a particularly ambitious attempt to apply this principle to chronic care, which accounts for a significant portion of healthcare spending. Chronic conditions like heart disease, diabetes, and arthritis affect millions of Americans and are often managed through ongoing, complex care plans. The traditional fee-for-service system often incentivizes quantity of care over quality, potentially leading to fragmented and costly treatments.

What Does This Mean for Patients and Providers?

The potential benefits of ACCESS for patients are clear: more coordinated care, increased access to technology-enabled support, and a greater focus on achieving measurable health improvements. However, the lower payment rates raise questions about whether providers will be willing to participate, particularly those serving vulnerable populations who may require more intensive care management.

Cadence’s decision to join the program, despite the financial challenges, suggests the company believes it can successfully navigate the model and demonstrate value. It remains to be seen whether other health tech companies and providers will follow suit. The success of ACCESS will likely depend on several factors, including the availability of effective AI-powered tools, the willingness of providers to embrace new care models, and the ability of CMMI to refine the payment rates based on early program results.

The Role of Technology in Value-Based Chronic Care

The expectation that artificial intelligence will be crucial for success in ACCESS underscores the growing role of technology in healthcare. AI can automate tasks such as data analysis, patient monitoring, and personalized care plan development, potentially reducing the burden on clinicians and improving efficiency. However, it’s important to acknowledge the limitations of AI and the need for human oversight. AI algorithms are only as good as the data they are trained on, and biases in the data can lead to inaccurate or unfair outcomes. The implementation of AI-powered tools requires careful consideration of data privacy and security.

Mario Aguilar, a health tech correspondent at STAT, covers these developments closely. His reporting focuses on the intersection of technology and healthcare, including the challenges and opportunities presented by digital health tools. Aguilar’s perform highlights the complex interplay between innovation, policy, and patient care.

FDA’s Digital Health Focus and Leadership

The increasing emphasis on digital health is also reflected in recent leadership changes at the Food and Drug Administration (FDA). In February 2026, the FDA appointed a former executive from a health artificial intelligence company to lead its digital health center. This appointment, reported on LinkedIn, signals the agency’s commitment to fostering innovation in this rapidly evolving field while ensuring the safety and effectiveness of digital health technologies.

Looking Ahead: Program Evaluation and Potential Adjustments

The ACCESS program is scheduled to run for several years, and CMMI will closely monitor its performance. The agency will evaluate the program’s impact on patient outcomes, healthcare costs, and provider participation. Based on these findings, CMMI may adjust the payment rates or modify other aspects of the model. The results of ACCESS will likely inform future efforts to expand value-based care and leverage technology to improve chronic disease management. It’s a process of continuous refinement, driven by data and a commitment to improving the health of Medicare beneficiaries.