Resources

Earlier this month, CMS launched the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, prompting renewed discussion across the digital-native health, AI-forward coaching, and accountable care sectors. ACCESS is part of a broader industry shift toward value-based, technology-enabled chronic care management. The model is distinctive in that it supports services like AI-enabled chat and coaching deployed at scale, which will be subject to the same regulatory scrutiny applied to any other covered clinical service. This combination of features merits sustained attention from technology-enabled healthcare solutions operating in adjacent markets.

The transition from hospital to post-acute care is one of the most under-engineered handoffs in American healthcare. Providers are navigating the convergence of clinical workforce shortages and rising patient acuity, which will only intensify as the population ages further. Momentum is building around technology-enabled solutions and payment reform that may help close the gap. In a piece for U.S. News & World Report, ATI Founder & CEO Anne Tumlinson identifies opportunities for hospitals to leverage new technologies and programs to improve the transition to post-acute care.

Roughly 12 million individuals are dually eligible for Medicare and Medicaid. This population is tasked with navigating these two systems simultaneously, facing fragmentation that neither program was designed to manage. Despite the many integration-focused models and programs built in recent years, the question of whether integration delivers value remains unanswered. ATI expert Allison Rizer provides considerations for how Medicare-Medicaid integration outcomes can be measured in Health Affairs.

The Medicare Advantage market is entering a period of renewed opportunity for regional and local plans. As national carriers continue to retrench from select markets amid mounting financial pressure, regional and local organizations have continued to grow, with enrollment increasing by 3.5 and 9 percent respectively in 2026.

In 2025, healthcare AI drew roughly $18 billion in venture capital — about 46 percent of all healthcare investment for the year — with adoption moving more than twice as fast as the broader economy. This capital is concentrating in prior authorization, revenue cycle management, and member engagement — the workflows touching Medicare and Medicaid beneficiaries most directly and where recent policy efforts have focused. With these shifts come urgent questions about governance and whether the promised efficiency gains will materialize for health plans, providers, and state agencies.

Following application submission, prospective Long-term Enhanced ACO Design (LEAD) Model participants are entering a planning window that will be key for shaping outcomes when the model begins on January 1, 2027. In a recent webinar, ATI experts Brian Fuller, Janelle Gingold, and Aaron Kirkman, as well as Sparx lead actuary George Kentros, walked through considerations for applicants in the coming weeks.