Medicare pays for activities, not outcomes. Jacob Shiff wants to change that. As chief AI and technology officer at the CMS Innovation Center, the R&D arm of Medicare and Medicaid, he helps direct an agency that he says spends roughly $2 trillion a year without the health outcomes to show for it. His answer is ACCESS, short for Advancing Chronic Care with Effective, Scalable Solutions, a new payment model that pays clinical organizations based on whether patients actually get better, measured by things like blood pressure, A1c, and depression symptoms.
Brenton and Jacob first met a decade ago at Flatiron Health, before Jacob founded a healthcare AI company and then went to work in government. Brenton and Galym ask what changes for a patient on Medicare, why fee for service often breaks down when software is the treatment, and whether an AI agent titrating blood pressure medication can be trusted.
Chapters:
0:00 Welcome to Venture Doctors
0:47 Introducing Jacob Shiff
1:25 Jacob Shiff's Path from Founder to the Government
3:29 The Listening Tour
7:51 The Access Model and How It Works For Patients
15:40 Expanding Beyond Medicare
19:17 AI Regulation and The Tempo Pilot
23:18 Government Service and Startup Speed At Scale
26:14 Advice for Founders Working with the Government
27:24 Underhyped Opportunities In AI And Healthcare
28:45 A Belief Most People Disagree With
29:57 What Jacob Is Digging Into Next
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