The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced the new Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model. The 10-year voluntary model is designed to expand access to new technology-enabled care options for patients with chronic conditions.
The ACCESS model is focused on patients with high blood pressure, diabetes, chronic kidney disease, chronic musculoskeletal pain and depression. These ailments currently affect more than two-thirds of Medicare beneficiaries.
ACCESS commences its 10-year run on July 1, 2026. Interested providers can fill in the CMS ACCESS Model Interest Form now, before the application goes live. Applications will start being accepted on Jan. 1, 2026.
Developed by the Center for Medicare and Medicaid Innovation (CMMI), a component of CMS, the model will give original Medicare a way to pay care organizations that develop technology-supported services. According to CMS, original Medicare has historically lacked a payment option to adequately fund technology-supported care. Fee-for-service methodologies pay for a defined set of activities that do not typically align with the way technology-supported care is delivered.
ACCESS is designed to address this issue by testing Outcome-Aligned Payments (OAPs), a payment option for Medicare-enrolled care organizations. Participating organizations will receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes. The model focuses on clinical improvement or control of a condition based on each person’s starting point. By rewarding outcomes rather than defined activities, ACCESS gives clinicians greater flexibility to deliver modern technology-supported care in ways that can improve patient health.
“Given a rising, aging population, it will be important to ensure our healthcare system can continue to meet patient needs. Unfortunately, under existing Medicare payment systems, patients have limited access to these tools, which means missed opportunities for patients to receive these benefits, and for providers who may otherwise be able to leverage these technologies in care delivery,” said Patrick Harrison, vice president of public policy at the National Alliance for Care at Home. “The ACCESS model is intended to help bridge that gap by tying monthly payments to measurable health improvements in order to help beneficiaries manage their conditions more effectively and reduce Medicare costs.”
Participation and enrollment
To participate in the model, providers must be enrolled in Medicare Part B, designate a physician clinical director who will be responsible for care quality and compliance, and meet all applicable federal and state laws, including HIPAA, licensure and applicable U.S. Food and Drug Administration (FDA) requirements.
The ACCESS model aims to:
- Empower people to achieve their health goals by improving patient access to new technology-supported care options to manage their chronic conditions
- Expand clinicians’ ability to offer innovative, technology-enabled care through a straightforward payment pathway
- Ensure that technology-supported care is clinician-guided, accountable and coordinated
- Promote transparency by publishing risk-adjusted health outcomes of technology-supported care so that patients and referring clinicians can make informed choices
Individuals with original Medicare coverage can enroll directly into the model, or be referred by a primary care provider or other physician.
“For palliative care providers, it is expected that most will act as the referring clinician,” said Ethan McChesney, senior policy director at the National Partnership for Healthcare and Hospice Innovation (NPHI). “In this case, the palliative care provider would coordinate with the actual participating organization.”
Harrison said palliative care providers are well-positioned to participate in ACCESS because the model’s goals closely align with what palliative care practitioners do every day.
“These practitioners and care teams focus on symptom management, psychosocial support, and promote coordination of care, which are core elements of chronic disease management,” Harrison said.
ACCESS also allows tech companies to contract directly with a participating organization, or enroll with Medicare Part B themselves to engage in the model, added McChesney.
The model will initially include four clinical tracks that focus on common chronic conditions. Each track includes disease-specific measures and outcome targets, with payment based on the proportion of patients who meet defined outcomes.
According to the American Health Care Association (AHCA), CMS will publish risk-adjusted outcomes in an online directory to ensure transparency, and to recognize and reward excellent clinical performance. The tracks include:
- Early Cardio-Kidney-Metabolic (eCKM): Hypertension, dyslipidemia, prediabetes and obesity or overweight with marker of central obesity
- Cardio-Kidney-Metabolic (CKM): Diabetes, chronic kidney disease, or atherosclerotic cardiovascular disease
- Musculoskeletal (MSK): Chronic musculoskeletal pain
- Behavioral Health (BH): Depression or anxiety
Participating organizations may offer multiple clinical tracks and are responsible for managing all qualifying conditions in each track, supporting integrated, patient-centered care. Care can be delivered in-person, virtually, asynchronously, or through other technology-enabled methods, according to the ACHA.
To help enrolled providers identify optional software and hardware tools that may support model participation and compliance, CMS will also launch an ACCESS Tools Directory.
Harrison said the model’s expanded access to technology will offer an opportunity for earlier detection and management of risk factors for patients, as well as continuous support through remote monitoring and digital coaching, and more integrated care that includes lifestyle modification, mental health counseling and education. He added that digital technology can play a central role in enabling a closer care relationship between a patient and their provider by allowing a patient to be a more active participant in their care journey.
“The use of digital technology will be important to ACCESS’s success. In the coming years, digital technology and AI have the potential to transform care delivery by facilitating a more data-centered and proactive approach rather than reactive,” Harrison said. “Digital technology can never entirely replace the human aspect of care delivery in certain environments such as in the patient’s home, however, it has the potential to supplement and enhance the care provided. Rather than paying for specific devices or technologies, this model’s monthly outcome-aligned payments are intended to provide organizations with the flexibility to use the tools and technologies that best meet individualized care needs.”
McChesney said another flexible component of the ACCESS model is the option for participating organizations to waive cost sharing for outcome-aligned payments, which will encourage beneficiary participation and reduce financial burdens for patients.
“Beneficiary cost-sharing is widely seen as the leading barrier for patient participation in care management and monitoring services,” McChesney said.
Once ACCESS launches, Harrison said CMS will expect participants to deliver integrated, technology-supported care across the conditions they manage. These services may include clinical consultations, chronic disease management, lifestyle and behavioral counseling, therapy and counseling, patient education, medication management, diagnostic imaging and use of FDA-authorized devices to meet patient needs. He said that participants will be able to provide care in a manner that best meets patient needs, either in-person, virtually, or both, along with other appropriate methods to manage patient conditions.
“Overall, this model was important for CMS to develop. [It] brings much needed attention on innovative solutions to support the 6-in-10 Americans living with chronic illness,” McChesney said. “Integration of tech companies into care management; aligning the patient’s primary care provider (or other referring clinician) with the participating provider and a tech platform could offer unique findings and insights.”
Harrison is also optimistic about the possibilities with ACCESS.
“With this model, there appears to be a real opportunity to leverage technology in ways that have never before been possible,” he said. “Digital technologies, such as telehealth, remote patient monitoring and other technological innovations, can benefit patients by empowering them to be more active participants in their health, while allowing clinicians to intervene early and better manage chronic conditions.”
