Transforming Chronic Care Management in Medicare: The ACCESS Model

Providers managing patients with chronic conditions have long faced difficulties due to the mismatch between healthcare delivery and Medicare's payment system. Chronic illness often necessitates ongoing care that extends beyond traditional in-office services. Historically, Medicare’s fee-for-service (FFS) model reimburses discrete services, largely overlooking continuous and preventive care. To address this, the Centers for Medicare & Medicaid Services (CMS) has recognized these limitations and aims to support technology-enabled and proactive chronic care management.

CMS, through its Center for Medicare and Medicaid Innovation, launched the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) on July 5, 2026. This model represents a 10-year initiative to test an outcome-aligned payment (OAP) system designed to enhance access to chronic care services that traditional Medicare does not fully support.

ACCESS targets specific chronic conditions rather than broadly applying population-wide risk assessments. These conditions, referred to as “tracks” by CMS, impact over two-thirds of Medicare beneficiaries. Participation is open to Medicare Part B-enrolled providers or suppliers, with exceptions like certain durable medical equipment and laboratory suppliers. Organizations must appoint a Medicare-enrolled physician as a clinical director, responsible for oversight, quality control, and compliance. This aligns with the model’s requirements and guidelines, urging interested entities to evaluate their readiness before applying.

The ACCESS framework employs OAPs, linking recurring payments to improvements in patient health outcomes. Conditions-specific metrics ensure providers are accountable for patient results. Unlike the volume-driven traditional reimbursement method, ACCESS ties payments to performance on beneficiary-yielded outcome targets relative to baseline measurements for each condition.

CMS sets benchmarks called outcome targets, focusing on controlling or improving health conditions. Providers must submit monthly claims, and CMS pays 100% of the anticipated annual OAP amount over the first six months of a 12-month care period. Further payments depend on outcome achievement during the second half of the period, with annual reconciliation based on achievements.

Technology forms a crucial part of the ACCESS model, with an integrative approach rather than separate reimbursements. This method enhances chronic condition management through technology-focused services like clinician consultations, lifestyle support, coordinated care, and medication management. The model supports the use of FDA-authorized devices and digital health technologies, requiring organizations to effectively incorporate these tools into care strategies.

As Medicare evolves towards an outcome-focused payment model, ACCESS provides providers an opportunity to align their care delivery with tangible results. Providers should evaluate their capabilities, explore partnerships, and consider their strategic participation timing to adapt to this changing reimbursement landscape.