CMS Launches ACCESS Model for Tech-Enabled Chronic Care Value-Based Payments

The Centers for Medicare & Medicaid Services (CMS) has introduced the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, a new voluntary value-based payment system under Original Medicare. This model aims to enhance access to technology-enabled care for beneficiaries with chronic conditions such as high blood pressure, diabetes, chronic musculoskeletal pain, and depression by linking payments to health outcomes rather than activities. It encourages healthcare providers, digital health firms, and other stakeholders to deploy scalable tech-supported services that supplement traditional care and focus on prevention and patient co-management. The 10-year ACCESS Model will start its first performance period on July 1, 2026, running through June 30, 2036. Participating organizations, including physician groups and chronic care vendors, must enroll in Medicare Part B and comply with federal and state regulations. They will be responsible for collecting baseline health data for patients to monitor and reward health outcomes through Outcome-Aligned Payments (OAPs). The model also incentivizes primary care providers and referring clinicians with co-management payments to foster collaborative care. A notable feature of ACCESS is enabling Medicare beneficiaries to directly enroll with participating organizations or through referrals. CMS will maintain a public directory of participating providers and their clinical outcomes to enhance transparency. Additionally, the model provides regulatory flexibilities, including safe harbor protections for waiving beneficiary cost-sharing on OAPs to boost patient engagement, while ensuring co-management payments remain free from cost-sharing. ACCESS intends to influence broader payer markets by encouraging adoption beyond Original Medicare, including Medicare Advantage Plans which have flexibility to implement similar payment arrangements. CMS has also clarified that OAPs count as medical expenses for payors' medical loss ratio calculations, potentially affecting reimbursement structures and compliance reporting. Legal and regulatory guidance firms like Nixon Peabody are monitoring ACCESS closely to support organizations interested in participating, particularly around Medicare enrollment, digital health regulations (HIPAA and FDA compliance), and other relevant compliance issues. This development indicates a significant shift towards outcome-based reimbursement models integrating technological innovations in chronic care management, with potential impacts on provider workflows, payer structures, and patient engagement strategies in the Medicare ecosystem.