Medicare Pilots Telehealth for Prenatal Care
Medicare's new CMMI ACCESS 2026 pilot is deploying telehealth platforms to improve prenatal care for high-risk and underserved groups. The outcome-based program uses digital visits to supplement traditional care, with results expected to inform state Medicaid programs.
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year nationwide voluntary program kicking off July 5, 2026. It aims to improve care for Medicare fee-for-service beneficiaries with chronic conditions by removing barriers to technology-enabled solutions. Applications for the first cohort of participants are due by April 1, 2026. This model introduces "outcomes-aligned payments," a shift from paying for specific services to rewarding results. Participating providers will receive fixed payments for managing qualifying conditions over 12-month periods, with the full amount dependent on achieving clinical targets like lowered blood pressure. This gives care teams the flexibility to use various technologies and approaches to meet patient needs. The ACCESS program initially targets four clinical tracks: early and late-stage cardiometabolic and kidney conditions, musculoskeletal issues like chronic pain, and behavioral health conditions such as depression and anxiety. This focus addresses conditions affecting over two-thirds of people with Medicare. Beneficiaries can enroll directly with a participating organization or be referred by their provider. To encourage coordination, primary care physicians and referring clinicians can receive co-management payments of about $30 per service for reviewing patient updates from ACCESS participants. There's also a one-time $10 bonus for assisting with beneficiary onboarding. These co-management payments are limited to approximately $100 per year for each beneficiary. In conjunction with this pilot, the FDA has launched the Technology-Enabled Meaningful Patient Outcomes (TEMPO) pilot. This program may grant temporary enforcement discretion for new digital health technologies used within the ACCESS model, allowing for real-world data collection to support future FDA authorization. Telehealth has demonstrated the potential to bridge significant gaps in maternal healthcare, especially in "maternity care deserts" where over half of rural counties lack obstetric services. Studies show that telehealth can increase timely access to prenatal care, improve monitoring of high-risk pregnancies, and enhance patient satisfaction by reducing travel and time off work. Research indicates that mothers in areas with limited maternal care access have a 230% higher likelihood of scoring in the high-risk range for postpartum depression. Telehealth can help by facilitating regular mental health screenings and providing immediate virtual access to behavioral health services and other support like lactation consulting and peer groups. Hybrid models of care, which combine a reduced number of in-person visits with telehealth appointments, have shown similar clinical outcomes to traditional care for low-risk pregnancies, along with higher patient satisfaction. These models effectively increase patient engagement and can help mitigate barriers like transportation and childcare.
