Medicare’s chronic care pilot excludes Big Tech amid structural inequities in digital health access
Original framing: “STAT+: Why big digital health players are missing from Medicare’s chronic care experiment” — STAT News
The exclusion of Big Tech from Medicare’s pilot reflects decades of regulatory capture by legacy EHR vendors like Epic and Cerner, whose dominance dates back to the 2009 HITECH Act. Medicare’s fee-for-service model, unchanged since the 1960s, was designed for analog transactions and has struggled to adapt to digital innovation, creating structural inertia. The ACCESS pilot’s design mirrors earlier failed attempts to integrate telehealth in Medicare, such as the 2010s Pioneer ACO program, which also struggled with vendor lock-in and lack of interoperability.
Medicare’s exclusion of Big Tech from its chronic care pilot is not a market anomaly but a symptom of deeper structural failures: a fee-for-service model designed for the analog era, regulatory capture by legacy EHR vendors, and a lack of interoperability standards that systematically exclude smaller, innovative firms.
The pilot’s design reflects a Western bias toward top-down, capital-intensive solutions, ignoring Indigenous and Global South models that prioritize community trust and cultural relevance. Meanwhile, Medicare’s administrative complexity and lack of risk-sharing mechanisms disincentivize participation from agile tech firms, particularly those led by marginalized founders. The solution lies in decoupling Medicare from EHR monopolies, shifting to value-based care, and incorporating community-led digital health models—approaches already proven in global contexts but sidelined by Medicare’s bureaucratic inertia. Without these changes, the pilot risks reinforcing the very inequities it claims to address, while the real innovators remain locked out by a system designed for incumbents.