A new Medicare payment model called ACCESS is quietly laying the groundwork for artificial intelligence to play a direct role in patient care, establishing for the first time a federal mechanism to reimburse AI-driven services such as remote patient monitoring, medication reminders, and social care coordination — a development that has largely flown under the radar of the broader technology industry.
For decades, the United States healthcare reimbursement system has been structured around discrete clinical encounters: a doctor's visit, a procedure, a hospital stay. If a patient needed a follow-up call between appointments, a housing referral, or a reminder to pick up a prescription, there was no standardised way for Medicare to pay for it — let alone pay for an AI system to handle it.
The ACCESS program, a new Medicare payment model, changes that. According to reporting by TechCrunch, the model creates the first governmental mechanism to reimburse AI agents that monitor patients between visits, conduct check-in calls, coordinate social services, and support medication adherence — tasks that have historically fallen into an unpaid gap in the care continuum.
The significance of this shift is difficult to overstate. Medicare serves more than 65 million Americans, and its reimbursement structures effectively set the standard for how healthcare is delivered and funded across the country. When Medicare pays for something, the rest of the insurance industry typically follows. By creating a billing pathway for AI-assisted care coordination, ACCESS could catalyse widespread adoption of health AI tools that have so far struggled to find a sustainable commercial model.
Despite its potential implications, the program has attracted surprisingly little attention from the technology sector. Most AI companies focused on healthcare have concentrated their efforts on clinical decision support, diagnostic imaging, and administrative automation — areas with clearer existing reimbursement pathways. The between-visit care gap that ACCESS addresses has been largely overlooked.
Health policy experts note that the practical barriers to deploying AI in this space remain significant. Questions around patient privacy, liability for AI-generated recommendations, clinical validation, and equitable access for lower-income or less digitally literate Medicare beneficiaries will all need to be addressed as the model scales.
Nevertheless, the creation of a payment mechanism represents a foundational shift. Without the ability to bill for AI-driven care coordination, even technically capable and clinically validated tools faced an insurmountable commercial barrier. ACCESS removes that barrier, at least in principle, opening a pathway that health technology companies, hospital systems, and AI developers are only beginning to understand.
Analysis
Why This Matters
- Medicare's reimbursement decisions shape how care is delivered across the entire US healthcare system — private insurers typically follow Medicare's lead, meaning ACCESS could unlock a large commercial market for AI care coordination tools.
- Millions of high-risk Medicare patients experience preventable deteriorations between clinical visits; AI-assisted monitoring could reduce hospital readmissions and improve outcomes at scale.
- The program signals a broader federal openness to integrating AI into the care delivery model, with potential regulatory and funding implications for the health technology sector.
Background
Medicare, administered by the Centers for Medicare & Medicaid Services (CMS), has long operated on a fee-for-service model that rewards clinical volume rather than continuous care management. Efforts to shift toward value-based care — where providers are paid for patient outcomes rather than individual services — have accelerated since the Affordable Care Act of 2010, which created the Center for Medicare and Medicaid Innovation (CMMI) to test new payment models.
Despite this evolution, the reimbursement framework has never adequately addressed the space between formal clinical encounters. Remote patient monitoring codes were introduced in recent years, but these have been narrowly defined and inconsistently applied. AI tools capable of conducting conversational check-ins, triaging symptoms, or navigating social determinants of health have existed in various forms, but without a billing code, their deployment has depended on grants, pilot funding, or absorption into existing care management fees.
ACCESS represents the latest — and arguably most significant — attempt to close this gap, establishing a dedicated reimbursement pathway tailored to the capabilities of modern AI systems.
Key Perspectives
Healthcare AI developers: Stand to benefit significantly from a defined payment pathway, which removes one of the primary commercial obstacles to scaling AI care coordination products. Many are likely reassessing their go-to-market strategies in light of ACCESS.
Patient advocates and clinicians: Cautiously supportive of tools that extend care reach to underserved or high-risk patients, but concerned about ensuring AI systems are clinically validated, equitable, and do not replace human judgment in critical decisions.
Critics and skeptics: Warn that reimbursing AI agents without rigorous outcome standards could incentivise low-quality or intrusive tools, raise privacy risks for vulnerable populations, and create new vectors for healthcare fraud — a persistent challenge in Medicare billing.
What to Watch
- Whether major commercial insurers begin mirroring ACCESS reimbursement codes in their own plans, which would signal broad market adoption.
- CMS guidance on clinical validation requirements and liability standards for AI agents billing under ACCESS.
- Early outcome data from ACCESS pilot participants, which will shape whether the model expands, contracts, or is modified in subsequent rulemaking cycles.