I’m thrilled to sit down with Faisal Zain, a renowned healthcare expert whose deep expertise in medical technology has shaped the landscape of diagnostics and treatment. With years of experience in the manufacturing of medical devices, Faisal has been at the forefront of innovation, helping to bridge the gap between cutting-edge tech and patient care. Today, we’ll dive into the newly introduced ACCESS Model by the CMS Innovation Center, exploring its potential to revolutionize chronic disease management through technology. Our conversation will touch on the implications of long-term payment programs, the shift to outcome-based rewards, patient access to tech solutions, provider collaboration, and the role of new tools like public directories in driving tech adoption.
How do you see the ACCESS Model’s 10-year payment program for chronic conditions like diabetes and hypertension transforming the landscape for health tech companies, and what steps might a company take to make the most of this opportunity?
I’m really excited about the ACCESS Model’s 10-year payment structure because it provides a level of stability that health tech companies have been craving for years. Historically, reimbursement has been a massive hurdle—many innovative tools, like prescription digital therapeutics, simply couldn’t get Medicare coverage due to statutory limitations. This long-term commitment from CMS means companies can invest in research and development with confidence, knowing there’s a predictable revenue stream if their FDA-cleared tech delivers results. I recall working with a startup a few years back that struggled to scale a diabetes management app because of inconsistent funding; a model like this would’ve been a game-changer for them. For a company looking to capitalize, the first step is ensuring their product aligns with the model’s focus on outcomes—say, lowering blood pressure or managing blood sugar. Next, they’d need to build partnerships with Medicare Part B providers who can integrate their tech into care plans, and finally, they should leverage CMS resources to navigate the application process, which runs from 2026 to 2033. It’s a marathon, not a sprint, but the payoff could redefine how chronic care tech evolves.
What are your thoughts on the shift to outcomes-aligned payments in the ACCESS Model, where Medicare providers are rewarded for results rather than specific services, and can you share a story or example that illustrates the potential benefits or challenges of this approach?
I think the move to outcomes-aligned payments is a bold and necessary shift—it’s about time we prioritized results over checkboxes. Rewarding providers for achieving goals like lower blood pressure or better glucose control gives them the flexibility to tailor care, whether through tech or traditional methods, and that’s incredibly empowering. I remember a pilot program I was involved with a few years ago for hypertension management; we used a tech platform to monitor patients remotely, and providers were incentivized based on sustained blood pressure reductions. The upside was clear—patient engagement soared because they felt the care was personalized, and we saw a noticeable drop in emergency visits over 18 months. But the challenge was in the datnot all providers had the infrastructure to track outcomes accurately, and some felt the targets were too rigid, leading to frustration. So while I’m optimistic about ACCESS, I believe CMS will need to offer robust support for data collection and ensure the benchmarks are realistic to avoid alienating smaller practices. It’s a balancing act, but if done right, it could set a new standard for value-based care.
With CMS waiving co-payments for services under the ACCESS Model, how do you envision this impacting patient access to technology for conditions like obesity or depression, and what broader effects might we see in patient engagement?
Waiving co-payments is a massive win for patient access, especially for conditions like obesity and depression where cost barriers often prevent early intervention. When patients don’t have to worry about out-of-pocket costs, they’re far more likely to embrace tools like remote monitoring devices or digital therapeutics, which can be lifesavers for managing chronic issues. I recall a community health program I advised on where we provided free access to a mental health app for low-income patients with anxiety—within six months, usage rates tripled, and participants reported feeling more connected to their care team because the financial stress was gone. This kind of policy under ACCESS could spark similar engagement, creating a ripple effect where patients are more proactive, leading to better outcomes and potentially lower long-term costs for Medicare. Beyond that, I think we’ll see a cultural shift—patients might start demanding tech-enabled care as a norm, pushing providers to adopt these solutions faster. It’s like removing a locked gate; once it’s open, people rush through, and the landscape of care delivery could change dramatically.
The ACCESS Model offers referring providers up to $100 annually per patient for co-managing care in tracks like Behavioral Health or Cardio-Kidney-Metabolic. How do you think this incentive will shape collaboration between providers, and what dynamics might emerge from this structure?
I believe this $100 annual incentive per patient is a smart nudge toward better collaboration, especially in complex tracks like Cardio-Kidney-Metabolic or Behavioral Health where multiple providers often need to coordinate. Financial carrots like this can motivate referring providers to stay engaged, ensuring they’re not just passing off patients but actively co-managing care plans. I saw something similar in a past value-based care initiative I worked on, where a small monetary bonus for shared care led to a 30% increase in communication between primary care docs and specialists over a year—think more phone calls, shared notes, and joint decisions. Under ACCESS, I expect we’ll see stronger care teams forming, with referring providers taking a more hands-on role in tracking outcomes alongside specialists. The dynamic could foster trust and accountability, but there’s a risk of tension if roles aren’t clearly defined or if one party feels they’re doing more work for the same reward. CMS will need to provide clear guidelines on responsibilities to keep this collaboration humming smoothly. It’s a small dollar amount, but the impact on teamwork could be profound if managed well.
CMS is creating a public directory for ACCESS Model providers with tools for data exchange and HIPAA compliance. How do you see this resource influencing tech adoption among providers, and can you walk us through how it might be used in practice?
The public directory and accompanying tools are a fantastic step toward demystifying tech adoption for providers, many of whom have hesitated due to complexity or compliance fears. Having a centralized resource that lists ACCESS providers and offers solutions for data exchange, interoperability, and HIPAA compliance lowers the intimidation factor—it’s like handing someone a map instead of expecting them to wander through a maze. I’ve seen the power of similar resources firsthand; a few years back, a regional health network I consulted for used a state-provided portal to integrate telehealth tools, and within a year, adoption jumped by 40% because providers had clear guidance and discounted tech options. With ACCESS, I imagine a provider starting by accessing the directory to identify peers already in the model for collaboration or advice. They’d then explore the listed tools—say, a connected blood pressure cuff or a secure data-sharing platform—and use CMS resources to ensure compliance. Next, they might apply for special discounts offered by tech providers through the directory, integrating these solutions into their workflow. The challenge will be ensuring the directory is user-friendly and regularly updated; otherwise, it risks becoming a forgotten tool. Still, if done right, it could be the catalyst that gets reluctant providers over the tech adoption hump.
What is your forecast for the future of chronic disease management with models like ACCESS paving the way for tech integration in Medicare?
I’m incredibly optimistic about the future of chronic disease management with initiatives like ACCESS leading the charge. I foresee a world where technology isn’t just an add-on but the backbone of care—think real-time monitoring, personalized digital interventions, and seamless data sharing becoming standard for Medicare beneficiaries. Over the next decade, I predict we’ll see a significant reduction in preventable hospitalizations for conditions like diabetes or hypertension as these tools catch issues early, saving billions in downstream costs. But the real game-changer will be the cultural shift—patients and providers alike will come to expect innovation as a right, not a luxury, much like we expect smartphones to evolve every year. The challenge will be equity; ensuring rural or under-resourced areas aren’t left behind in this tech wave will be critical. If CMS can balance innovation with accessibility, we’re looking at a future where chronic care isn’t just managed—it’s mastered.
