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Value-Based Care Lit the Match. Precision Health Is the Accelerant.

How the convergence of the ACCESS Model and consumer health tech delivers the ultimate unlock, transforming daily health behaviors in an entirely unprecedented way.

Author

Dana Prommel Strauss
May 31, 2026

VBC Lit the Match. Personalized Medicine Is the Accelerant.

Why my partner is right that nothing much has changed yet, and why I think he's about to be wrong.

My partner spends his days in the rooms where the grand theories of healthcare policy go to face reality. After thirty years as a nursing home social worker, and now in hospice, he has seen exactly how the system treats its most vulnerable.

So when I get excited about value-based care—about a system designed to reward keeping people well rather than tallying up procedures—he gives me a look I’ve come to know well.

"Dana," he says, "I've been doing this for three decades. I’ve watched you work in value-based care for one. On the ground, nothing has changed."

And when I push, he doubles down, conveying that we are dealing with deeply ingrained legacy expectations. This generation has spent decades being conditioned to want constant treatment and endless testing. Until that consumer demand naturally shifts, the game won't change.

He’s right about a lot of it from his lens. He sees the absolute downstream results of our delivery system and its incentives. But working now in hospice, where the incentives actually are aligned, gives him a unique baseline. And I still think he’s about to be wrong, for a reason that has less to do with the traditional levers value-based care has spent fifteen years pulling.

Take the skeptic seriously

Prevention's signature is an absence of something. The heart attack that didn't happen. The pre-diabetes that never converted to insulin dependence. The middle-of-the-night ER admission that never materialized. The vaccine-preventable disabling disease that faded away with a prior generation. (But on that, we seem to have a short memory.)

Because my partner’s entire career has been spent managing the Medicare population in these downstream roles, he has arrived at an entirely understandable conclusion: little has changed.

The clinician at the end of the line is structurally the last to see prevention working, because prevention's biggest victories are the people who never show up in his facility. It’s a completely valid vantage point. And any honest case for change has to start right there, facing that reality, or it's just hype.

So let me make the honest case.

VBC has been largely a supply-side project

Value-based care, as we've built it, is almost entirely a supply-side strategy. It changes how the delivery system gets paid. Shared savings, capitation, full risk, penalties…you get the picture. Every single one of those is an external incentive pointed at the people delivering care.

Is it a necessary step to change the system? Absolutely. Does it have limitations on its own? Also absolutely.

External incentives aimed at large swaths of the healthcare economy are exactly the kind of changes that are slow, diluted, and entirely invisible at the bedside. A healthcare delivery organization can quietly restructure a corporate contract, but the nurse, the social worker, and the patient feel absolutely nothing different over the course of months or even years.

That is the exact ceiling my partner keeps bumping into. His skepticism describes both an absence of progress and the structural limits of a model that has spent fifteen years pulling primarily one lever.

The lever VBC never had a way to substantively pull is the one inside the patient. Patient engagement and empowerment are non-negotiables if we want to bend the cost curve at wide scale, especially when the cost of individual units of care is rising faster than inflation itself. But real behavioral change is something value-based care has never been able to manufacture at scale using a payment formula aimed strictly at care delivery teams.

Working in the VBC business and in policy, I have seen pockets of progress here. We're starting to see it in the new generation of AI-assisted care management systems that help clinicians engage with patients more authentically, for example.

One example is from a company called CareCo. (I’ve never worked with the tool myself and have no affiliation.) My understanding of how it works is when a care team member pulls up a patient chart, the system surfaces (among other things) info from their past conversations and reminds them of small personal tidbits the patient shared on a prior call. It helps build genuine trust and relationship continuity in a much more seamless way.

Another approach is embedding resource-intensive clinical care teams directly into physician practices to build the kind of patient-clinician alliances that drive actual behavior change. This can work beautifully and meaningfully, too.

But both of these models face the exact same hurdle: they are incredibly difficult to scale widely.

Does Fixing Healthcare Require a Generational Shift? I Don't Buy It

His theory is that demand is the real bottleneck. We are stuck with an entire generation conditioned to equate good care with more care, and the only path forward is waiting on a generational turnover.

If the only way to shift that demand is through traditional, slow-moving public health campaigns, he’d be right. But the tool arriving to disrupt that demand pattern is highly personalized, always-on digital health tech. And that’s why his premise begins to fall apart.

First, the idea that older patients are a tech-proof wall that this strategy will crash into is mostly a story the industry has told itself to excuse slow progress. The data simply doesn't bear it out. KFF's Drew Altman put it bluntly in a recent column titled “Medicare Beneficiaries Are Not Luddites”: roughly 8 in 10 Medicare beneficiaries 65 and older used a healthcare app or website in the past year. Even more striking, a majority reported that it made the system easier to navigate, showing no meaningful difference in adoption or utility when compared to 30-to-49-year-olds. (To be fair to the skeptics, the survey does highlight real income gaps and genuine worries about AI privacy. Adoption isn't uniform, but it is widespread.)

Second, and this is the heart of the matter: “treat, treat, test, test” is a learned behavior, but that doesn’t make it a fixed behavior. It’s the natural byproduct of a system that spent decades teaching patients that the only way to "do something" about their health is to get a scan, secure a referral, or undergo a procedure. Of course patients demand volume! We trained them to.

Personalized, continuous feedback offers a completely different way to feel like you're taking action. The shift moves from “the doctor ordered another test” to “my own daily numbers are moving, and I can see it.” 

The new Medicare payment model tests are engineered to pay for exactly that swap. They reward the actual outcome rather than the volume of tests and visits that produced it.

You don't have to wait for a generation to pass away to change the game.

You do have to change what taking action feels like.

The near term is already here

This isn’t a “someday” argument. Look at what is hitting the market right now.

Earlier this year, Paralympian Hunter Woodhall got an biometric alert from his Oura ring. (Story found here.) It pushed him to see a doctor immediately, and he was diagnosed with appendicitis before his appendix could rupture. That is the entire ballgame in a single anecdote: catching an acute medical event before it transforms into a devastating, five-figure hospital admission and human suffering. It’s also why Oura, which is now an 11 billion company with over 5.5 million rings sold, just filed to go public explicitly as a healthcare company, not a fitness gadget.

There’s already an example of a payer realizing they are worth the investment. Missouri's Essence Healthcare is now giving Medicare Advantage members a free Oura ring. Think about it. When the entity holding the financial risk hands out a continuous, biometric engagement tool for free, the traditional incentives have quietly inverted.

But the biggest structural shift just landed on the fee-for-service side.

CMS’s Innovation Center has launched the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions), a 10-year voluntary test in Original Medicare with a first performance period beginning July 5, 2026. If you want to see where the external payment lever and the internal consumer lever finally click into the same gear, this is it.

The design of the model does a few radically new things:

  • It creates a dedicated billing pathway for tech: Historically, fee-for-service Medicare paid for a rigid, face-to-face set of activities that completely ignored how digital, asynchronous care is actually delivered. Many digital health companies survived by avoiding Medicare and selling straight to employers. ACCESS changes the plumbing.

  • It pays for outcomes, not volume: Participating organizations receive a recurring Outcome-Aligned Payment (OAP) to manage a patient’s condition. The amounts are deliberately modest and meant to be “deflationary.” They range from 180 dollars per patient per year for musculoskeletal and behavioral health, up to 420 dollars for complex cardio-kidney-metabolic cases. That is a rounding error compared to a single avoidable ER visit.

  • It features a strict 50% skin-in-the-game withhold: CMS holds back half of every payment, reconciling it at the end of the year. An organization only earns that withhold back if at least half of their patients hit a clinical target set relative to their own individual starting point. Examples are a meaningful drop in a personalized pain or A1c score. No one-size-fits-all bar. Plus, CMS will publicly post these risk-adjusted outcomes. The intent is that the platforms that actually deliver results win the trust of the public, healthcare delivery teams, and policymakers.

  • It explicitly penalizes what it considers duplicative care: It’s debatable and remains to be seen if some of this penalized “duplication” or “substitution” is a good idea. I’m skeptical about some of that. The ideas is that if an enrolled patient starts accessing certain services elsewhere, the model automatically docks the managing organization's payment. Digital management is explicitly engineered to substitute for the volume play. Example: someone who is enrolled with an ACCESS org to manage chronic musculoskeletal pain should theoretically not seek an evaluation from a physical therapist or initiate remote therapeutic monitoring services.

The model’s four tracks target the rising-risk, prevention-adjacent conditions that touch more than two-thirds of the entire Medicare population. (CMMI notes additional tracks are coming in the future). More than 150 organizations were accepted for the launch, many of them entirely new to serving Medicare, and major commercial health plans have already pledged to roll out their own ACCESS-aligned payment options by 2028.

Supply side, meet demand side.

The pillar everyone forgets is the patient experience

We talk about value-based care as cost and outcomes. But the foundational Triple Aim eventually became the Quadruple Aim to protect clinician well-being, and has now rightly expanded into the Quintuple Aim to explicitly incorporate health equity. Yet through all these iterations, the patient’s actual experience of care has remained the hardest pillar to move.

This is exactly where agentic AI and digital tools are beginning to quietly do some of that work.

An AI "navigator" that handles the logistics like booking an appointment, rescheduling it, explaining a complex lab result at 11 p.m., and routing you to a human clinician only when it truly matters is important because they remove the structural friction from the parts of healthcare people actually hate.

And we don’t engage in things we hate unless we have to, which makes that behavior inherently downstream.

The industry sees the potential. While health system executives are still figuring out the backend plumbing, consumers are already moving ahead on their own. A March 2026 Microsoft Research report, "How people use Copilot for Health", analyzed more than 500,000 real-world health conversations. The data shows that conversational AI has quickly become an active first point of contact for patients triaging new symptoms, parsing complex medical records, and managing medications. The demand side isn't waiting for the supply side to catch up.

Here is the exact part that ties back to my partner’s skepticism: trust starts low, but it is earned through direct experience.

A national survey by National Opinion Research Center (NORC) at the University of Chicago found that most US adults have low baseline trust that their health system will use AI responsibly. Yet, separate data shows that patients with personal experience using AI show meaningfully greater approval of it in healthcare. Trust gets built through positive, day-to-day interactions, not corporate press releases.

That trust flywheel is already spinning faster than the skeptics realize. Rock Health’s 2025 Consumer Adoption Survey, which surveyed 8,000 US adults, found that roughly a third (32%) have already turned to AI chatbots for health information, doubling the share from just a year prior. Even better, 64% of those users return weekly or more.

Two findings also speak directly to the Quintuple Aim goal of equity:

  • The Equity Gap is Breaking: Unlike earlier waves of digital health tools that tracked strictly with wealth, the data showed no meaningful differences in AI adoption across income or education levels.

  • It Drives Real-World Action: An astonishing 81% of AI users took a concrete action afterward. Those actions include things like researching a health behavior, tracking a symptom, or going to see a doctor. That number is almost unbelievable.

KFF’s independent polling from early 2026 initially landed in the exact same place, confirming that about a third of adults were using AI for health info. However, that baseline is already outdated. A spring 2026 study by Boston Consulting Group shows just how fast this curve is accelerating, finding that nearly 60% of consumers are now using generative AI for personal health, and 44% are interacting with health chatbots on a weekly or daily basis. General web searches are quickly giving way to active, conversational interactions.

There are honest caveats to list, of course. Some are: most people remain highly worried about data privacy, chatbots still hallucinate, and always-on availability can sometimes outrun standard clinical guidelines. But the direction is unmistakable. And the technology is improving exponentially at a pace never seen in prior technology rollouts.

Engagement, experience, trust, and equitable access are the loop that VBC’s external payment levers could never close on their own. I believe they are finally closing from the inside out.

The long game

I started thinking about all of this after hearing Eric Topol speak about his book, Super Agers. Driven by everything from semaglutides to AI, Dr. Topol bets that we can meaningfully prevent and delay the chronic diseases of aging decades before they ever manifest. A recent MedCity piece, “Aging is Soon to Be a Preventable Disease,” makes the same case. They note that the biology is currently running ahead of the clinical tools, which are running ahead of the payment systems required to scale them.

But the tools are catching up. Take a term that is about to enter everyday conversation. Or maybe you heard it here first! It’s the Polygenic Risk Score (PRS).

Unlike a traditional single-gene test (like BRCA) that hunts for one high-impact mutation, a PRS adds up the tiny effects of thousands, sometimes millions, of common genetic variants across your entire genome. As the National Human Genome Research Institute (NHGRI) points out, it doesn't give you a definitive diagnosis or a timeline. Instead, it gives you your relative risk compared to everyone else. Knowing you are in the top 1% of inherited risk for type 2 diabetes or heart disease changes the game, allowing for hyper-targeted screenings and lifestyle interventions decades before a symptom appears.

The caveat is that most of the genetic data behind these scores comes from people of European ancestry, making them currently less accurate for everyone else. It’s a massive equity problem that the field is actively working to fix.

When you pair polygenic risk scores and longevity medicine with AI that excels at early diagnosis, you get the ultimate long-term accelerant: healthcare that is predictive, deeply personal, and aimed at the right person before they are sick.

If you want the cleanest proof that the timeline for prevention can actually be collapsed, look at GLP-1s. Semaglutide and its cousins are the first prevention-adjacent interventions with an effect size that’s large and fast enough on impacting weight, A1c, and cardiovascular outcomes that potentially a payer can underwrite the ROI.

It would be a major unlock if the time-to-benefit fits neatly inside the window that a risk-bearing organization is actually accountable for.

Closing the loop

Value-based care spent fifteen years pulling the external lever of paying delivery systems and clinicians to behave differently. The ACCESS model is the most serious, outcome-aligned version of that work that we have ever seen.

An external, corporate payment lever alone was always going to feel completely invisible from where my partner stands.

The real “kerosene on the flame” is the internal lever.

Personalized, continuous, and highly visible tech-enabled feedback can have the power to make a distant health payoff feel immediately present. It creates a smooth patient experience that actually earns consumer trust. It is the exact engagement mechanism that shifts a patient's mindset from "go get treated, go get tested" to "let me actively manage this." 

Longevity medicine, advanced upstream diagnostics, and agentic AI tools light the crucial intrinsic motivation we need to change the direction of healthcare in this country.

So here is what I tell my partner and others like him now:

You are completely right that the day-to-day on the ground looks the same right now. Prevention’s wins are the hospital admissions that never happen, and you have spent three decades standing exactly where the structural failures show up over and over.

But we don't have to wait around for a massive demographic shift to change the game. We just need to give patients a tool that makes "taking action" feel like something other than demanding another test. Eight in ten Medicare beneficiaries already opened a health app this year. The time-to-benefit on chronic metabolic disease has completely collapsed. A risk-bearing payer will now hand a senior a free biometric monitor because the math finally pencils out.

And this summer, Medicare officially starts paying based on whether those patients actually get better. The question isn’t whether structural change is coming. It’s which lever pulls next. For maybe the first time in the history of healthcare policy, that lever belongs to the consumer.

It’s all connected.

Sources:

*Disclaimer: All opinions and ideas expressed in this article are solely mine and none represent a recommendation or should be viewed as advisement of any kind to anyone to do anything.*

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