Opportunities for CMS to Improve Healthcare Access and Equity through Advancing Technology-Enabled Startups and Digital Health Innovations

Historically, the Centers for Medicare and Medicaid Services (CMS) has formed partnerships with select private sector entities, including large traditional hospital and health system networks, nursing homes, and payer groups. However, innovations from technology-enabled services companies and digital technology companies are uniquely poised to aid CMS in addressing key barriers toward advancing its mission of improving healthcare access and equity. There are four pivotal opportunity areas where partnerships with technology businesses and tools would enhance the work of CMS: (1) improving consumer awareness about CMS programs, (2) mitigating access gaps through virtual care programs, (3) streamlining the complexity of different payer plan models, and (4) using technology-enabled services to address social risk factors without imposing additional burdens on providers. We offer examples of digital and technology-enabled solutions that improve patient access to care and close equity gaps, as well as propose specific recommendations for CMS to advance and expand the reach and impact of these solutions. Namely, these recommendations include partnerships with private sector companies that can educate and support consumers about their benefits, the extension of telehealth reimbursement parity for virtual care solutions, allowing for cross-state licensure across plans and reimbursement for care coordination services that alleviate provider burden to screen and address patients’ social determinants of health needs. We argue that CMS has an imperative role in leveraging the innovations of technology-enabled services and digital health technologies to lower healthcare access barriers, mitigate provider burden, stimulate innovation, and close equity gaps at the patient, provider, and innovator levels.