Alternative Payment Models
Expert articles and analysis related to alternative payment models.
AI Summary — Last 7 Days
CMS is signaling a broader Trump administration push to scale technology-enabled alternative payment models: the ACCESS model is being expanded for 2027 to additional chronic conditions including COPD, substance use disorder, and tobacco cessation, while companies such as Oura and Counsel Health join the model to test wearables and AI-supported chronic care at Medicare scale (Healthcare Dive). At the same time, CMMI Director Abe Sutton is positioning the WISeR Medicare prior authorization pilot as a template for future federal payment integrity efforts, despite provider pushback and reported implementation problems, underscoring a growing tension between cross-payer alignment, AI-enabled utilization management, and provider burden (HFMA). For ACOs, health systems, and payers, the week’s pattern is clear: CMMI is moving toward tech-forward chronic care and specialty/payment integrity models, but operational readiness, data infrastructure, and clinician acceptance will determine whether these models create value or simply add administrative friction.
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Oura, Counsel Health join CMS ACCESS model to test whether wearables and AI can improve chronic care at scale
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CMS announces expansion of ACCESS Model - aha.org
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