CMS Introduces ACCESS Model to Enhance Technology-Based Chronic Care in Medicare
CMS Prepares to Launch the ACCESS Model
How a decade-long experiment could reshape chronic care and payment alignment in Original Medicare
The Centers for Medicare & Medicaid Services is laying the groundwork for what could become one of the most influential value-based care models in a generation. The ACCESS Model, formally known as Advancing Chronic Care with Effective, Scalable Solutions, is expected to begin on July 1, 2026 and run for ten years. It is voluntary, ambitious, and aimed squarely at one of the toughest challenges in health care today: improving chronic disease outcomes at scale.
At its core, ACCESS represents a shift toward payments that reflect what matters most to patients and payers alike. Instead of reimbursing for isolated activities, CMS plans to reward participating organizations for achieving measurable improvements in conditions like hypertension, diabetes, chronic musculoskeletal pain, and depression. It is a rethinking of accountability and a recognition that technology-enabled care can expand reach, consistency, and efficiency.
“Outcome alignment is the natural next step for Medicare as we move from services performed to health improved.”
Attributed to a CMS Innovation Center official
A New Way to Pay for Chronic Care
ACCESS introduces what CMS calls Outcome-Aligned Payments. These are recurring payments tied directly to patients achieving clinically meaningful improvements based on guideline-driven measures. It is an attempt to fill the long-standing gap in Original Medicare, where payments are typically activity-based instead of outcome-based.
Participating organizations must meet several requirements. They must be enrolled in Medicare Part B, adhere to regulatory standards such as HIPAA and FDA rules, and appoint a physician Clinical Director who oversees clinical operations. These requirements reflect CMS’s effort to ensure safety, quality, and clinical accountability in a model heavily grounded in virtual, in-person, and asynchronous care modalities.
To encourage collaboration, primary care providers and specialists can refer patients into the ACCESS program and will receive regular electronic updates regarding progress. CMS is also introducing a co-management payment option that compensates referring clinicians for the time they spend coordinating care.
“ACCESS could make technology-supported chronic care feel less like a patchwork and more like an integrated system.”
Attributed to a primary care industry leader
What Makes ACCESS Different
Here is one section in bullet points, as requested, highlighting distinguishing features:
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Payments tied to patient improvement instead of discrete services
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Multiple care delivery modalities including virtual and asynchronous support
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Public reporting of aggregated outcomes to promote transparency
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Four clinical tracks organized around common chronic conditions
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Rural adjustment and flexible payment design to encourage broad participation
The Four Clinical Tracks
The model organizes patients into tracks that reflect shared needs and evidence-based clinical measures. The tracks are aligned with conditions that carry a high burden in Medicare and have robust guideline-supported outcome measures. This structure is designed to help organizations develop expertise, scale interventions, and reduce variability in patient experience.
Below is a simple overview table:
| ACCESS Track | Primary Focus | Example Outcome Measures |
|---|---|---|
| Hypertension | Blood pressure control | % of patients achieving guideline-aligned targets |
| Diabetes | Glycemic management | A1c improvement thresholds |
| Musculoskeletal Pain | Function and pain reduction | Patient-reported functional improvement |
| Depression | Symptom reduction | Validated depression score improvement |
Flexibility and Patient Choice
CMS is positioning ACCESS as a model that expands options rather than restricts them. Patients retain all Original Medicare benefits and can continue seeing their existing physicians. Enrollment is voluntary and can coexist with other Medicare services. The model simply creates an additional layer of coordinated, outcome-focused support.
Importantly, although ACCESS is specific to Original Medicare, CMS acknowledges that Medicare Advantage plans may adopt similar concepts independently. Many observers expect MA plans to watch the results carefully and borrow innovations that prove effective.
Oversight, Privacy, and Accountability
CMS plans extensive oversight throughout the ten-year model. Organizations that fail to meet standards or compromise patient safety can be removed. HIPAA-compliant, interoperable systems will support data exchange for eligibility, enrollment, and care coordination.
From CMS’s perspective, robust oversight is essential to public trust. From the industry’s perspective, clarity on expectations may encourage responsible innovation and support investment in scalability.
Why the Insurance Industry Should Pay Attention
ACCESS is more than another demonstration. It is a large-scale test of payment alignment, digital-enabled care, and outcome transparency in Original Medicare. If successful, it could influence commercial markets, Medicare Advantage benefit design, and employer-sponsored plans.
For insurers, this model signals growing momentum for approaches that reward long-term improvements instead of short-term activity counts. It also underscores the need for payer-provider alignment, data interoperability, and strong clinical governance.
Whether the industry sees the ACCESS Model as an opportunity or a challenge, it is undeniably a sign of where CMS believes chronic care must go. The next decade will reveal how ready the ecosystem is to follow.