Alex (00:00) Let us rock and roll. It's been a while. It's been a while since we got our hands dirty in this process. So looking forward to see where the discussion leads us today.
Dana Strauss (00:10) So we thought we would talk a little bit about the access model, the CMMI model for essentially for digital health and the opportunity in the MSK space. So kind of to recap, what is the access model? It's a model by the Innovation Center that is allowing a new type of provider to have Medicare Part B status.
essentially digital health companies that don't right now have any way to build traditional healthcare because there is no billing code for digital health. CMMI created this because they do not want to create just a regular fee for service code that can be billed like a big hockey stick that goes up like they see in any code that they create that has broad application. And so these payments are intentionally very low.
And they're based on, 50 % of them is based on the outcomes achieved and their ability to avoid similar spend depending on the category of care provided. So the models in four tracks, two of them are cardio metabolic health. One is early stage cardio metabolic. The second is late stage. And then the third and fourth are musculoskeletal care and behavioral health. And the musculoskeletal care one is
is what we obviously are gonna chat a little bit about here. I will say interesting about the access model is that Dr. Oz called it a model to try to reduce costs for Medicare beneficiaries.
think part of the reason for that is the model participants are allowed to waive the copay entirely as part of the model, which can't be done normally under Medicare statute. So there is no cost at all. is, know, beneficiaries sign up for the model themselves. And one of the things that we were talking about on the webinar that I participated in this past week,
was the opportunity for a partnership between primary care practices and the ACOs that they partner with plus primary care or plus physical therapy providers plus did access organizations.
did you have any takeaways or things that you heard other folks saying after it or questions that are coming up?
Alex (02:28) did. first, I think you did a spectacular job in the webinar. So you and Mark and everyone else was on the call, did a good job breaking down that subjective complexity of this model. I think you definitely aligned it with the industry.
It's also helpful to know and to see the optics of how a physician who's involved with a model sees the application of this model and sees the downstream rewards of this model being successful and how and whether that directly translates to success on a musculoskeletal side. So to me, my takeaway was to hear physicians on a call.
to discuss this model and where it is. And then of course, one being a little bit more physical therapy oriented and the other one is being a little bit more aligned with a surgical primary care ownership of this model. The points that I think that continue to resonate with me is that the subjective complexity that is being put out there, whether we are creating some of this complexity based on excessive analytics into what this model.
would be in a way instead of just calling it for what it is. And if you call it for what it is, you can take an Occam's razor to it, is just keeping things simple when the simplicity is the best fitting answer. And I think it's a model that allows some level of financial reward for presence in technology for ongoing chronic disease management and with the domains of chronic disease that you just mentioned.
So it was really good to hear you guys discuss this. The constraint, which is something that we discussed briefly before we went live, is I think we were creating a little bit of an echo chamber where we'll continue to discuss this model among people who are incentivized to understand the notice model. But anyone outside of this echo chamber becomes more oblivious to it because there's just no immediate resonance to it. And so...
having had discussions with some of the executives on the legacy side, there's just very little understanding. There's very little immediate application. And they don't see this as an opportunity either. So you and I both know the importance of this model. We both know the importance of aligning with these emerging solutions. We also know the threat of being delaying this alliance. But we're still not penetrating.
Dana Strauss (04:46) Yeah, I mean, I agree.
think I'm concerned at a high level, Alex, about the ability for the therapists who have not really tuned in much to how accountable care functions, the upsides, the reasons to participate in the mechanics of accountable care. And that's really where the opportunity lies here is.
in thinking of this model as a new wedge for a wedge and a reason for primary care providers and those accountable for total cost of care to care about musculoskeletal care. Like when we've done the definitions of what is accountable care a bunch of times, but the 10 second recap in an ACO.
the participants of the ACO are financially responsible for all of the spend for all the patients that they're responsible for, which is essentially, you know, if you're a primary care provider, it's who do you take care of on an annual basis. And musculoskeletal care is around the, it's in the top, it's usually the top three spend, sometimes top two, diabetes and kidneys, you know, one and two oftentimes, right?