Claims / C-B2K4D9MDGR
EmpiricalRequires evidence
Medicare's first national outcome-aligned payment for technology-supported chronic care (the ACCESS model, ten years from July 2026) pays for the right thing in form and the old thing in substance: it pays the organisation for a result rather than an activity, which is new, but the result is control of a condition the person already has, measured by a biomarker such as a 15 mmHg fall in blood pressure. That is outcome pay on the already sick, scored on a surrogate, not pay for disease that does not happen.
Evidence 1 passage
backsSource document
Participating organizations will receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes. The model focuses on clinical improvement or control of a condition based on each person’s starting point, for example, helping a patient with hypertension lower their blood pressure by 15 mmHg.
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