| When the CMS Innovation Center debuted ACCESS, Omada Health seemed like a shoo-in. |
| The 10-year program tests paying for tech-enabled care for Medicare patients with chronic diseases. It gives digital health companies a way into a huge market for seniors that’s otherwise been tough to crack. |
| Yes, the health tech industry has grumbled about the program’s low payment rates. But I was still a little surprised when Omada’s name wasn’t on the list of more than 150 companies participating at launch. (CEO Sean Duffy had initially praised the program.) |
| When I caught up with Duffy last week after Omada’s first-quarter earnings call, he explained that the “structure and reimbursement” just didn’t work. |
| “Credit to CMS; any program that takes a swing of helping with chronic disease, obviously we're rooting for,” he said. But, he continued, “it became clear to us that it would be difficult to provide a high quality, clinically governed program that we felt could be both safe and effective.” |
| There are other questions, too. How do seniors find out about these new care options? Direct-to-consumer companies have marketing channels that might work to their advantage, but Omada would need to get patients by partnering with health systems, Duffy said. And while health systems will get some payments for partnering with ACCESS providers, “my assessment was it wasn't a level that rose to the top of anybody's strategy desk.” |
| Duffy is hopeful the program evolves, but his reservations highlight some key challenges CMS may need to address. I’ve written before that the low payment rates are meant to attract companies that don’t have a clinician-heavy model. But if patients can’t find those tools to begin with, we’ll never know how effective (or not) they
can be. |
| - Shelby |
