In this month’s episode of the Debunked Podcast, co-hosts Arundhati Parmar (MedCity News editor-in-chief) and Samir Batra shared thoughts on how the CMS ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) is working since its roll out in July, with attention on the recent expansion of the initiative to cover more chronic conditions.
Batra, who serves as Managing Partner of Health Innovation Pitch, noted that “value-based care is not dead, but it’s in rehab.”
ACCESS ties payments to patient outcomes and encourages tech-enabled, preventive care. A recent expansion of the program added heart failure, COPD, substance use disorders and tobacco cessation to existing tracks for hypertension, diabetes and behavioral health for anxiety and depression. That tech-enabled care can include remote monitoring, digital behavioral health programs and virtual care management teams. Batra pointed out that the ACCESS model is a lot better than efforts to make other versions of VBC work because the monetary formulas to pay digital health companies in these programs were often convoluted and frustrating.
AI, of course, was also part of the discussion. The healthcare industry seems a little torn between the time AI tools can save on labor-intensive administrative work, such as credentialing but tech companies’s explanations for how their algorithms arrive at their answers continues to be a source of frustration.
The move by Last Week Tonight Host and comedian John Oliver to dedicate an entire show to breaking down the size and breadth of services and functions of UnitedHealth Group and its numerous subsidiaries was also part of the conversation. The episode focused on how insurers delay, deny, or complicate care through policies and prior authorization. It also talked about UnitedHealthcare as a symbol of broader problems in private insurance.
In August, Luigi Mangione changed his plea to guilty over the murder of UnitedHealthcare CEO Brian Thompson, which happened in December 2024. Mangione is expected to be sentenced December 18.
