CMS Launches ACCESS Model to Modernize Medicare Chronic Care Payments

The Centers for Medicare & Medicaid Services (CMS) has launched the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a voluntary initiative aimed at integrating technology-supported care management for Medicare beneficiaries with chronic conditions. The ACCESS Model targets prevalent conditions such as hypertension, diabetes, chronic musculoskeletal pain, and depression, affecting millions of Americans, including two-thirds of Medicare recipients. It shifts Medicare payment structures by aligning reimbursements with measurable, patient-specific health outcomes rather than paying for individual services. This outcome-aligned payment model rewards providers based on clinical improvements, such as reducing blood pressure by a targeted amount, thereby incentivizing better management of chronic diseases. The model encourages the utilization of telehealth, wearable devices, digital coaching tools, and other innovative technologies to enhance patient care and expand access to technology-enabled services, especially for populations that have faced barriers to such care. CMS emphasizes that this model provides greater flexibility for clinicians, supporting the strengthening of care teams and improving patient-physician relationships. The AMA has expressed support for the model, highlighting its potential to modernize chronic disease management and remove outdated payment barriers hindering technology adoption. To participate, healthcare organizations must apply by April 1, 2026, for the performance period beginning July 1, 2026; late applications will be considered for a January 1, 2027 start. The ACCESS Model distinguishes itself from prior efforts by focusing on specific clinical outcomes for grouped chronic diseases rather than bundled payments or global risk assignments for total care costs. This approach aims to streamline care management and payment structures while rewarding high clinical performance based on risk-adjusted outcomes reported publicly by CMS. The initiative reflects CMS’s broader efforts to reform Medicare payment models towards value-based care systems and foster the adoption of digital health technologies to improve chronic care outcomes. Resources and application details are available on the CMS website, alongside AMA’s advocacy materials supporting Medicare payment reforms and value-based care adoption. The ACCESS Model represents a significant development within the ongoing transition toward outcome-driven healthcare financing in the Medicare program, with implications for providers, payers, and patients managing chronic illnesses in the U.S.