Why Fee-for-Service Can’t Handle AI Care: Dr. Will Gordon on CMS ACCESS | The Policy Stack

Click here for more: https://shorturl.at/56lNv In this episode of The Policy Stack, host Lisa Bari talks with Dr. Will Gordon, who was the first Chief Informatics Officer at the CMS Innovation Center and a senior advisor to the CMS Administrator on technology and interoperability. He helped architect CMS ACCESS and several other models now in the field. He is also a practicing physician and clinical informaticist, and is now a senior advisor at Manatt Health. They start with the core problem. Most providers still get paid for activity: the more you do, the more you bill. That structure made sense for human-delivered care, but it breaks down with technology. As Will puts it, a physician can’t see 80 patients a day, but an AI agent managing blood pressure isn’t limited by activity at all. Paying for outcomes is not a new idea. The reason it never took hold is that outcomes are genuinely hard to measure, which is why ACCESS is built on well-validated, non-controversial measures like blood pressure and HbA1C. 0:00 Paying for outcomes, not activity: what CMS ACCESS is 1:15 Meet Dr. Will Gordon 2:24 From software developer to physician to the Innovation Center 5:35 Joining CMS and building data strategy across administrations 8:02 Why the Innovation Center stays consistent across political change 11:23 The old way: bespoke data systems for every model 13:36 Model Space and centralizing the Innovation Center’s data 15:15 Getting data to participants: bulk FHIR APIs and pre-adjudicated claims 18:39 The interoperability gap CMS can’t close alone 21:16 The CMS ACCESS model: launch, participants, and how it works 22:49 Why activity-based billing and technology don’t fit together 25:02 Paying for outcomes, and why it’s so hard to measure them 27:38 Why not just create a new billing code? 29:03 Bundling, pay-for-performance, and the 50% outcomes withhold 31:36 The four clinical tracks and how enrollment works 38:42 Patient acquisition cost and scaling care delivery 40:17 Cherry-picking, selection bias, and the evaluation 47:36 Requiring FHIR APIs and pushing the ecosystem forward 48:42 The policy stack behind Access 51:19 Multi-payer alignment: will commercial and Medicaid follow? 53:01 Where to find Will The conversation covers how the model actually works (four clinical tracks, a roughly 50% payment withhold tied to outcomes, a twelve-month episode), the data plumbing that finally makes real-time outcome measurement possible (the Innovation Center’s Model Space environment, bulk FHIR APIs, and pre-adjudicated claims data that cut the usual 18-month lag), the interoperability gaps CMS cannot solve alone (it has claims data, but not clinical or ADT data), and whether commercial plans and state Medicaid agencies will adopt the same framework. It’s a fitting conversation for where healthcare is heading. When payment rewards outcomes instead of activity, the routine, rules-based work becomes a candidate for automation, and clinicians’ time and judgment go to the patients and decisions that actually need them. That is the shift we’re building toward at Innovaccer: autonomy in operations that keeps people in control of the calls that matter. The episode closes on why Access may become the chassis that replaces how we reimburse remote monitoring today. The Policy Stack is available on YouTube, Apple Podcasts, Spotify, and most major podcast platforms. #innovaccer #healthcare