Market and Reimbursement 2026: RPM, Digital Therapies, and New Payment Logic — What to Prepare For

Why Payment Logic for Digital Care Is Shifting Heading into 2026

As 2025 closes, the most consequential changes in digital health are not coming from new devices or algorithms, but from how care is being paid for. Budget planning and contract renewals heading into 2026 reveal growing discomfort with reimbursement models that reward activity rather than sustained clinical management. In this context, payment logic itself is becoming the primary site of innovation.

For several years, much of connected health growth relied on CPT-based monetization, particularly in remote patient monitoring (RPM) and digitally supported chronic care. While effective in early adoption phases, this approach increasingly shows structural limits. Payers and providers alike face administrative burden, variable utilization, and weak alignment between billed activity and long-term outcomes. As value-based care expands, these frictions are becoming harder to justify.

Market reporting by Axios highlights why new models are gaining attention. The announcement of the Medicare ACCESS trial set to launch in 2026 with fixed payments for chronic condition management signals a willingness to decouple reimbursement from line-item technology use. Instead, technology is treated as an enabler within a broader care bundle, not as a separately monetized service.

This shift reflects converging pressures. Public payers are seeking predictability and scalability. Providers want fewer billing complexities and clearer accountability for outcomes. Technology vendors face increasing scrutiny over whether their tools genuinely reduce downstream costs or simply generate reimbursable interactions. Against this backdrop, pilots are evolving: they are no longer tests of technical feasibility, but experiments in payment design. The implication for 2026 planning is significant. Digital care solutions will increasingly be evaluated on how well they fit into prospective, condition-based, or population-level payment structures. Engagement metrics and usage volume matter less when reimbursement is fixed. What rises in importance is whether a solution supports clinical stability, reduces avoidable utilization, and integrates seamlessly into care delivery.

As digital care matures, payment models are catching up and forcing a strategic reset across the connected health market.

What New Models Are Emerging: RPM, Digital Therapies, and Fixed Payments

The shift in payment logic heading into 2026 is most visible in how payers are rethinking reimbursement for remote patient monitoring (RPM) and digital therapies. These modalities sit at the intersection of technology and care management, making them natural candidates for experimentation with new payment structures. Traditional RPM reimbursement has been largely activity-driven. Billing depends on device usage, data transmission, and documented clinician time. While this model helped catalyze adoption, it also tied revenue to operational throughput rather than clinical impact. Variability in patient engagement, inconsistent data flows, and documentation burden have made these arrangements difficult to scale, especially in systems already moving toward value-based care.

In response, payers are increasingly testing fixed or prospective payments for chronic condition management. Rather than reimbursing each monitoring interaction, these models compensate providers for managing a defined population over a set period. The Medicare ACCESS trial exemplifies this direction: technology-enabled care is assumed, but not billed separately. The economic question shifts from “how much monitoring occurred” to “was the condition managed effectively.” This logic has important implications for digital therapies as well. Under fixed-payment models, standalone engagement metrics lose relevance. What matters instead is whether a digital intervention can demonstrably support adherence, stability, or avoidance of higher-cost care. Digital therapeutics that integrate tightly with clinician workflows and treatment plans are better positioned than tools that operate in parallel.

Another emerging feature of these models is risk redistribution. Fixed payments expose providers and, by extension their technology partners, to performance risk. This raises the bar for evidence and reliability. Vendors must show not only that their products work in pilots, but that they can perform consistently across broader, more heterogeneous populations.

The overarching signal is clear. Payment is shifting from usage to management, from transactional billing to longitudinal responsibility. For connected health companies, success in 2026 will depend less on maximizing billable events and more on enabling durable, outcome-oriented care within constrained payment envelopes.

Strategic Impact on Connected Health Companies: What Stops Working

As payment models evolve, several strategies that supported digital health growth over the past few years are becoming materially less effective. Heading into 2026, connected health companies are discovering that technical adoption alone no longer guarantees commercial viability if the business model is misaligned with emerging reimbursement logic.

One of the most visible pressure points is the decline of pure CPT arbitrage. Models built primarily on maximizing reimbursable events, such as device activations, data uploads, or short bursts of clinician time, are increasingly fragile. Under fixed or blended payments, higher utilization does not automatically translate into higher revenue. In some cases, it becomes a cost rather than a benefit. This shift elevates the importance of outcome evidence. Payers and providers now expect digital solutions to demonstrate measurable impact on clinical stability, utilization patterns, or total cost of care. Evidence generated in tightly controlled pilots carries less weight than data from real-world deployment across diverse patient populations. Companies that cannot translate engagement into outcomes risk being excluded from broader contracts.

Integration also becomes a strategic differentiator. Tools that sit outside core clinical workflows struggle to justify their place when payment is bundled. In contrast, solutions embedded directly into care pathways, supporting medication management, escalation decisions, or longitudinal monitoring, are easier to defend under population-based contracts.

Organizationally, these changes affect sales cycles and partnerships. Contracting increasingly involves providers and plans jointly, extending timelines but also raising stakes. Vendors must be prepared to participate in shared-risk or performance-linked arrangements, signaling confidence in real-world performance. The underlying message for 2026 is stark. Business models optimized for billing mechanics rather than care delivery are being stress-tested. Companies that fail to adapt may see adoption stall, not because their technology lacks value, but because it no longer fits how value is paid for.

Questions for CEOs in Q1 2026: What Investors, Partners, and Payers Will Ask

Related articles

• Smart Pill Bottles + Gabapentin: Boosting Adherence in Neuropathic Pain Care
• Data-Sharing Agreements for Community Stewardship Programs: Balancing Privacy and Public Health
• Real-World Evidence: Reducing Antibiotic Overuse With Digital Nudges