Medicare Expands Pilot Paying for Tech-Assisted Chronic Disease Care

For millions of older Americans, managing a chronic illness is a daily grind of medication schedules, blood pressure checks, and phone calls that too often go unanswered. Now Medicare is betting that technology, paired with a new way of paying for it, can ease that burden. The federal government just decided to expand a program that pays companies to do exactly that, even though the effort has barely had time to prove itself.

The initiative, known as the ACCESS model, launched last year with a fairly narrow scope. It pays approved companies to help patients manage diabetes, high blood pressure, chronic musculoskeletal pain, depression, and anxiety. What makes it different from typical Medicare arrangements is the payment structure itself. Instead of simply reimbursing for services rendered, providers get paid more when their patients' health actually improves. Think of it like a landscaper who gets a bonus not for showing up and mowing the lawn, but for the lawn actually looking better a month later.

That outcomes-based approach is central to what regulators are trying to prove. Chronic disease management has long been a fee-for-service business: more visits, more devices, more billing codes, regardless of whether a patient's blood sugar or blood pressure actually gets better. The ACCESS model flips that incentive, at least in theory, toward results.

On Tuesday, the Centers for Medicare and Medicaid Services announced it would broaden the list of conditions eligible for the program. Substance use disorder, heart failure, chronic obstructive pulmonary disease, and tobacco use will all get their own tracks, along with an extended track for longer-term musculoskeletal support. These additions are not small tweaks. Heart failure alone affects roughly 6 million American adults, and COPD remains one of the leading causes of hospitalization among seniors. Substance use disorder, often overlooked in chronic care conversations, has become an urgent priority as opioid and alcohol-related deaths continue to strain families and health systems alike.

The new tracks are set to begin in spring 2027. Once they do, CMS estimates that about three in four people on Medicare will be eligible for at least one track under the program. That is a striking number. It means the vast majority of the more than 65 million Americans enrolled in Medicare could soon have access to a company managing at least one piece of their chronic health picture through this model.

How the Payment Model Works, and Why It's Being Watched Closely

It helps to understand why this expansion is happening so quickly. The ACCESS model is part of a broader push within CMS to test whether technology-enabled care, paired with financial incentives tied to outcomes, can bend the cost curve on chronic disease while also improving quality of life. Chronic conditions account for a staggering share of Medicare spending, and lawmakers on both sides of the aisle have been eager for models that promise savings without simply cutting benefits.

But there is a tension here worth sitting with. The original ACCESS model has barely gotten off the ground. Expanding it to five additional conditions before there is meaningful data on how the first version is performing is, to put it plainly, a leap of faith. Regulators are essentially building the plane while flying it, adding new passengers before checking whether the wings hold.

That is not necessarily reckless. Pilot programs often need scale to generate useful data, and waiting years for perfect evidence before expanding could mean delaying care improvements for patients who need them now. Still, patients and clinicians deserve transparency about what is being measured, how success is defined, and what happens if a company fails to hit its outcome targets. Will patients lose access to a service mid-treatment? Will companies quietly stop offering support for the hardest cases, the ones least likely to show quick improvement, in order to protect their bottom line?

That last question echoes concerns raised elsewhere in health policy circles this year. STAT News has also reported on problems with a separate Medicare pilot involving artificial intelligence in prior authorization, one that was rushed into launch and ended up delaying care for patients, according to internal documents. The lesson from that episode is not that innovation should be avoided, but that speed without oversight can hurt the very people these programs are meant to help. As CMS scales up ACCESS, it will need to avoid repeating that mistake.

There is also the matter of who administers all this. CMS Administrator Mehmet Oz has been a visible face of the agency's push toward value-based, tech-forward care models. Whether that vision translates into rigorous safeguards for vulnerable patients, particularly those managing substance use disorder or advanced heart failure, will determine whether this expansion becomes a genuine advance or another well-intentioned program that stumbles in execution.

Why It Matters

For the roughly 49 million Medicare beneficiaries living with heart failure, COPD, or substance use struggles who may soon qualify for one of these new tracks, the promise is real. Better coordinated, outcome-focused care could mean fewer emergency room visits, fewer medication errors, and more days spent living rather than managing a disease. For a diabetic grandmother juggling insulin doses or a veteran fighting both COPD and addiction, a well-run program that actually pays attention to whether they are improving could be transformative.

But the stakes cut both ways. If companies game the outcome metrics, or if the sickest and most complex patients get quietly deprioritized because they are harder to show improvement in, the program could end up widening the very gaps in care it was designed to close. Chronic disease management has always been hardest for the people with the fewest resources and the most complicated health histories. Any model built on financial incentives needs guardrails to make sure those patients are not left behind in the rush to hit performance targets.

The expansion of ACCESS is a bet on technology and better incentives fixing what fee-for-service medicine has struggled with for decades. Whether that bet pays off will depend less on how many conditions get added to the list, and more on how carefully regulators watch what happens to the patients now depending on it.