Header: CMMI produces a JAMA Op Ed on its "ACCESS" technology and chronic care program. I used an AI-generated essay to explain, then critique the program in some detail.
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This week, JAMA publishes an important paper from CMMI, which appeared online May 11. See:
- Outcome-Aligned Payments for Technology-Enabled Care—A New CMS Approach to Paying for Chronic Disease Care in Medicare.
- (2026) Shiff J & Sutton A. JAMA 335:1932-34.
- Online here.
- Clinician-facing ACCESS page.
- See an essay about possible trade-offs by Liao here.
I've been experimenting with longer-form AI-mediated writing, and I respond to Shiff & Sutton with a 10-page, 5000-word AI essay.
The ten-page essay is in the Google cloud as a PDF here.
The Essay Summary is here:
- CMS’s ACCESS model is a serious attempt to modernize Medicare payment for technology-enabled chronic care. Rather than paying for visits, devices, app clicks, or care-management minutes, ACCESS pays organizations for measurable improvement in chronic disease outcomes — an elegant and potentially important idea.
- But it also exposes a deeper CMMI paradox: under-managed Medicare patients may need more care, not less. Better management can mean more drugs, physical therapy, behavioral health, monitoring, labs, and specialist follow-up. Judged too narrowly on savings, ACCESS may reward low-cost "metric improvement" while discouraging the costly care activation patients actually need.
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Note on method.
The essay was generated by giving Chat GPT about 8 documents on ACCESS, including Shiff & Sutton, many CMMI webpages, and trade press. This let Chat GPT generate a thorough understanding & summary of the program.
Then, as I began to see some of the underpayment problems, I mostly dictated (in a long session on my iPhone) successive questions and concerns back and forth to Chat GPT. Finally, Chat GPT produced four versions of the essay (each one based on new updates and suggestions that came from me.)
The V4 7000-word essay was somewhat bloated, and I gave it to Claude Opus to rewrite and edit. Claude Opus spent about 15 minutes on the project and produced the draft I've uploaded here (as V5). Claude V5 was about 30% shorter than Chat GPT v4.
The cover page was generated by giving Chat GPT V3 and asking for a cover page:
- Make a portrait style 8.5x11 format report cover. It should be an interesting design but professional. do not use pictures. The author is Chat GPT, and the cover date June 2026. Include the 100 word abstract on the cover page. Probably you can deliver as PDF but JPEG is possible. If it is a 1 page PDF and can just add to the prior report. On the other hand, is it possible for you to generate a one page cover in 8.5x11 portrait format and deliver the whole rewritten document as the remainder or cotinuation of the PDF? If not, just do the page 1 cover.
