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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join host Jeff Byers, editors from Health Affairs Publishing, and guests as they discuss health policy’s most pressing news and trends.
Hello and welcome to Health Affairs This Week. I'm your host Jeff Beyers. We are recording on 05/07/2026. Today on the pod, we are going to talk about the Access Model, and here to talk about that today is Andrew Rundle from Columbia University Mailman School of Public Health. Andrew, welcome to the program.
Andrew Rundle:Thank you. Thank you for having me.
Jeff Byers:Yeah. So the Access Model is set to start in July this year. You wrote an article in Forefront. One of the things about being employed by Health Affairs Publishing is I had an early manuscript access to it. The title of it in the manuscript is the access model may set off a health tech gold rush, but new markets bring serious obstacles.
Jeff Byers:I don't know if that's what the published version of the title will be, but that's what I have on my desk. So let's back up a moment. What is the access model? What's its intent?
Andrew Rundle:Sure. So the ACCESS model, ACCESS is an acronym from Medicare and it stands for Advancing Chronic Care with Effective Scalable Solutions. And it's a new program from Medicare where beneficiaries of Medicare and their physicians will be able to use technology supported health care. And this is basically what Medicare is calling companies, e health companies or digital health companies or tech health companies that use technology to deliver healthcare services to patients. So think about mobile apps for helping people manage diabetes or manage their diet, or think about wearables that provide reports back to you on your health.
Andrew Rundle:Prior to access, Medicare did not cover the use of these types of products and services. And so Medicare's goal here is really to expand access to these new types of health care products and hopefully allowing people to use these products and getting reimbursed for these products is going to improve our ability to prevent and manage chronic health disease conditions.
Jeff Byers:So in this model, it's one of the many different types of models that CMMI have used to try to get more providers or Medicare beneficiaries in like an alternative payment model or, you know, value based payment, however you want to call it. It's part of their goal to try to get a certain number, can't remember the exact one, by 2030 for Medicare beneficiaries. A couple of different tracks. Andrew, do you have any information on the different kinds of tracks?
Andrew Rundle:At the moment, they seem to be focusing on, you know, what are the major sort of causes of death and morbidity in The US. So cardiovascular disease and the behavioral and chronic health disease conditions that feed into cardiovascular disease, and these are things like metabolic disease. So type two diabetes, hypertension are the big ones that were sort of called out in the announcement for access. I imagine it will expand if the program is successful, but these were sort of the areas that were highlighted in the announcement.
Jeff Byers:Yeah. And currently, the model is set to run through June 2036. So, Andrew, in your Forefront article, you say this model may set off a boom time for some companies. So can you explain why that might be the case?
Andrew Rundle:The Medicare population is really large. There's about 70,000,000 people that are enrolled in Medicare. And so access provides a way for these e health companies to get reimbursed by this patient population when this patient population uses their services. At the moment, these companies typically provide services to the employees of large corporations through corporate medical or wellness benefits programs. And setting up those contracts and then renegotiating those contracts takes a lot of time.
Andrew Rundle:I think what access is going to do is going to provide a way for these companies to go directly to patients. And then they're going to have this access to this built in reimbursement program through Medicare. So I think this is going be really attractive for companies who provide these services.
Jeff Byers:So serendipitously, on May 4, Heather Landy at Fierce Health Care wrote an article about, diving into the access model, and just one thing to note real quick. I think there is about 150 participants that were announced in the access model. Heather notes in her article, we'll put it in the show notes, that the two digital health companies, that went public last year, Omada and Hinge Health, chose not to apply for this model. And I think it's interesting to note that the representative from Omada Health, they say the program structure is on target, but they also say their assessment of payment levels don't cover the cost of delivering the evidence based care that Medicare beneficiaries deserve. So so I'm just curious for you, is that some of the obstacles that you see this new market will bring or what are the obstacles you're referring to in your Forefront article?
Andrew Rundle:Yeah, sure. I should say upfront that I'm an advisor to Armada, not necessarily on this issue, but I do have a relationship with Armada. We actually really focused on how these companies are going to have to think about the Medicare population, not really the economics of how much they get reimbursed for any given service versus the cost of their providing the service. So we really focus on thinking about the Medicare population as being quite different from the current populations that a lot of these companies serve. These companies typically serve employed individuals working for large corporations.
Andrew Rundle:And so these are individuals that are obviously working age. These are individuals that often have higher incomes, higher levels of education, and really importantly, higher levels of digital health literacy. When you think of the Medicare population, one of the characteristics is lower health literacy and lower digital health literacy. And so I think for these services and these products to take off, they really have to meet the Medicare population where they're at, which is really about thinking about how this population is going to interact with the services and products, taking into account they're probably going to be dealing with or working with a population that has lower health literacy than they're used to working with. So that was one point we were thinking through.
Andrew Rundle:And the second is that these companies, because they often sell to corporations so that the employees of these corporations can have access to the products, these e health companies are in a business to business marketplace. And what Access is really starting to propose is more of a hybrid business to patient and business to physician marketplace. And why I say it's hybrid is we expect that physicians are going to have a relatively large impact in whether or not patients start using these products and then continue to use these products. And so you've got a different marketplace that's going to have different sales requirements than the current marketplace. And we expect that physicians are going to require a higher level of evidence that these products are effective than the current sort of benefits manager at a large corporation usually requires.
Andrew Rundle:I think physicians are gonna ask for more and better data that these products work. And so this will be a new space, I think, for these companies to operate in.
Jeff Byers:Yeah. Let's touch on the tech literacy, for older adults. You mentioned that we hear this around every once in a while that older individuals, don't have as much tech literacy. But as the population ages and tech becomes more widespread, I do kinda wonder, is this true, or is this gonna naturally degrade over time? Or, like, what are your thoughts on, like, in ten years when you know, in twenty years when you and I are in 65, you know, how is this gonna look?
Andrew Rundle:Well, I'm guessing in twenty years from now, there will be new technology that I will not be literate in. But
Jeff Byers:For sure. Yeah. For sure. Yeah.
Andrew Rundle:I think the issue, though, is you're right. So that given the today's technology, the Medicare population will naturally become more literate in this technology. However, the access program is only authorized for ten years. And basically this is like a pilot or demonstration phase. And so the companies actually have to work with the population and the patients they have available to them now and demonstrate that they can improve health and demonstrate that they have a user base that wants to use these technologies with the current Medicare population.
Andrew Rundle:And so I think if we're successful in the coming ten years, then yes, your prophecy of greater health literacy will come true, and hopefully this program will still be providing means for the Medicare population to use this technology.
Jeff Byers:Yeah. Well, your words, prophecy, not mine. Even though, you know, I'm not saying I'm a prophet, but, I I appreciate the sentiment. But what about the current Medicare cohort? So, like, what you're in rooms I'm not in.
Jeff Byers:You know, you have data I don't have access to. What is the current tech literacy of older adults in America?
Andrew Rundle:If you're looking at the actual data, the data is embarrassingly out of date. So the available surveys on, health literacy nationally, the big national surveys are over ten years old. So if you work from those surveys, yeah, there's definitely a difference in tech literacy between older adults and working age adults. But it appears we have not collected national data recently. However, my colleague, Tamara Cadet, who is on this paper, this is her area of focus.
Andrew Rundle:She's working all the time in trying to create health products that are legible to older adults. And so, yeah, while we don't have hard data that's nationally representative that is up to date, I think this is still an issue that we face.
Jeff Byers:One final question on this, and thanks for taking this journey with me. So like what makes a piece of technology easier to use for older Americans?
Andrew Rundle:So we're talking about things like how, the the choice of words. Is this at a reading level that, is appropriate? Is the layout of the information? So like the graphic design, where the text is on the display, even if the font is large enough to be readable, these are all things that sort of fit into it. There are a variety of tools that people use in the field to sort of gauge whether or not the language and the word choices are appropriate for different levels of literacy.
Andrew Rundle:And there are tools that are used to sort of gauge whether the layout and the graphic design is really going to work. And so, you know, those tools need to sort of be applied to these products to help understand are they going to meet people where they're at currently and over the next ten years that this program is currently set up for?
Jeff Byers:So the access model is voluntary. You argue there could be a tech rush. One of the questions I had is, will the work needed to become, I have in my notes, a TSHCC that I don't remember what the acronym is for.
Andrew Rundle:Technology Supported Healthcare Company.
Jeff Byers:Thank you,
Andrew Rundle:Anthony. That's Medicare's acronym for companies that provide e health, digital health tools and products.
Jeff Byers:So will the work needed to become one of those companies, you know, will that work out economically for them if they have to put in some work to set themselves up for success? We touched on this briefly, but, like, there will have to be a little bit of a culture and product change to to help them out here. Is that right?
Andrew Rundle:I mean, that's what we're thinking. We're thinking it's gonna be a different sort of sales model, a different sort of information model that has to be provided. But this is a huge population, 70,000,000 people. The Congressional Budget Office estimates that between '27 and 2036, the Medicare population is going to grow by 15% and the actual Medicare spend will double. This is a marketplace with lots of patients, lots of patients that actually could use this technology.
Andrew Rundle:So my hope and expectation is that companies will make this investment. You noted earlier that something like a 150 companies have already signed up for this with some notable exceptions. I think it's clear that there is an appetite amongst these providers to enter this marketplace, and it's a marketplace that is both growing in size and growing in spend.
Jeff Byers:Thanks. Andrew Rundle, we still have a little bit of time here today. Again, I encourage individuals to check out the forefront article. We'll put the link in the show notes to that. Is there anything else you wanna touch on when it comes to the access model and your predictions for it?
Andrew Rundle:I mean, I think these e health tools, these digital health tools are very exciting as an area of health care, And I think that there's a potential for these tools to improve population health and individual patient health. In our article, we talk about a number of barriers beyond what we've discussed here today. Each of those barriers is going to require some effort to surmount. I'm optimistic. I'm an optimist, and I, you know, I have a wearable that I check every day, and, I think a lot of people do as well.
Andrew Rundle:So I'm
Jeff Byers:Yeah.
Andrew Rundle:Pretty optimistic.
Jeff Byers:Yeah. One final question since we still have some time. I appreciate the thoughts. I can't remember if it's in your forefront article, but the you know, again, we're on a podcast. I've said this before.
Jeff Byers:I'm gonna say it again. It wouldn't be a podcast without talking about AI. Is there anything when it comes to AI, a, within health tools, and b, within these kinds of health tools that may help that may be developed or that we may learn? I don't I don't know. I don't really have a specific question except can you touch on the fact that AI in this in this model and companies coming up?
Andrew Rundle:Yeah, I can. We talk about it in the article in one way, and we've been thinking about it in a couple of other sort of frameworks. So one of the issues is that under Medicare, providers have to provide their services in all languages spoken in The US. And so at the moment, we have these AI tools for doing translations. So like, you know, Google Translate, for instance, right?
Andrew Rundle:These companies are going to have to find ways to provide these translation services. And it occurs to us that it may be possible for AI to sort of instantaneously change the language on a interface for like a wearable, for instance, or on a web page when you look to see the results or the ongoing data from your wearable, for instance. So I think there's a place where AI could probably solve some of the language barriers, translation barriers that are likely to be an issue. And then the other issue is that sort of testing and developing and understanding whether or not a piece of health information is legible for individuals with varying health literacy. They're not particularly scalable.
Andrew Rundle:They're a little they're focus groups, for instance. The kinds of tools that you would use to assess whether or not your product is accessible are also time consuming to use. And so we're imagining ways in which AI can be used to sort of scale up sort of the testing of these tools for issues around health literacy. And so hopefully we can expand in that area using AI. So there is my obligatory AI comment.
Jeff Byers:Thank you. Thank you. Everyone everyone appreciates it. I appreciate it. Andrew Rundle, thank you again for joining us today on Health Affairs This Week.
Jeff Byers:It was a blast. To you, the listener, if you enjoyed this episode, please send it to a friend, and we will see you next week.