ACCESS: A Fix For Digital Health Companies, Not Medicare’s Costliest Patients Morish Shah Graham Walker Sudeep Bansal

https://www.healthaffairs.org/content/forefront/access-fix-digital-health-companies-not-medicare-s-costliest-patients Ten years ago, when the Affordable Care Act introduced risk adjustment for health plans, the logic was sound: Sicker patients cost more, so payment should reflect that reality. What followed was less inspiring. While well-intended, we now see that the Hierarchical Condition Category (HCC) system transformed the problem list into an optimization documentation exercise, where adding the right codes mattered more than delivering the right care. With the Center for Medicare and Medicaid Innovation’s (CMMI) new ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model, we risk optimizing enrollment instead of Medicare outcomes.