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CMS leaders push 'access' payment model and outcomes-based reimbursement for clinical AI
Summary
CMS and fellow HHS leaders promoted an access model designed to reimburse digital tools by outcomes, not volume; speakers said the approach aims to be deflationary and urged ACO participation and hospital pledges.
CMS officials and program leads described the 'access model' as a pathway to pay for digital and AI tools that demonstrably improve outcomes rather than reward volume. Abe Sutton (S7) and Stephanie Carton (S8) said the access model will help clinicians intervene between office visits, using the example of Patricia Ferguson, a Medicare beneficiary who benefited from remote supports in an ACO REACH model.
Dr. Oz (S4) stressed payment design concerns: if AI tools are paid inside a fee-for-service volume model they could be inflationary by increasing billable interactions; instead, CMS aims to pay for measured improvements in outcomes. "We only pay for AI if it is improving and we can measure the improvement in health outcomes," Carton said. The event included a call for health-system CEOs to pledge to enroll patients in the access model by September 15, but the transcript records that enrollment pledges are voluntary and operational details will follow.
