Manager   •   about 6 years ago

Q: How can a company strategize to get a effective digital health tools reimbursed by Medicare/Medicaid? Is there a formula?

A: Most companies that we have seen working in this space are using some variation of the Software as a Subscription (SaaS) model, which charges customers a recurring fee for using the product (e.g., x amount of dollars per employee who uses the tool every month). This link provides good information about digital health business models: As of right now, most products in this space are not relying on direct reimbursement from Medicaid/Medicare, but rather are being used by customers (delivery systems, health plans, social service organizations, etc.) to perform services that are reimbursable through Medicaid/Medicare. For example, many delivery systems operate programs where they bill Medicaid for providing "care coordination services;" these delivery systems may choose to purchase digital health tools with the understanding that they are a mechanism by which care coordination services can be provided, and hence billed for.


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