The ACCESS Model: Medicare’s Bold Step Toward Outcome-Based Technology-Enabled Care

The American healthcare system stands at a critical juncture. More than two-thirds of Medicare beneficiaries live with chronic conditions such as hypertension, diabetes, chronic pain, and depression—conditions that require ongoing management far beyond episodic doctor visits. Yet Original Medicare’s traditional fee-for-service payment structure has created significant barriers to accessing innovative, technology-supported care that could help millions of people better manage these conditions. The Centers for Medicare & Medicaid Services (CMS) is addressing this gap with the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, a groundbreaking 10-year initiative that fundamentally reimagines how Medicare pays for chronic disease management in the digital age.

The Problem: Payment Barriers in a Digital Health Era

The transformation of healthcare delivery through digital technologies has created a paradox in Medicare. While telehealth platforms, wearable devices, coaching apps, and remote monitoring tools have proliferated in the commercial market, Original Medicare beneficiaries have faced limited access to these innovations. The reason is structural: Medicare’s fee-for-service methodology pays for a defined set of activities—office visits, procedures, tests—that don’t align with how modern technology-supported care is delivered.

Consider a patient with hypertension. Traditional Medicare pays for quarterly office visits where blood pressure is checked and medications are adjusted. But comprehensive technology-supported care might include continuous blood pressure monitoring through a wearable device, regular virtual check-ins with a care team, personalized lifestyle coaching through an app, and real-time medication adjustments based on trending data. This integrated approach doesn’t fit neatly into existing billing codes, leaving both patients and innovative care organizations without adequate payment pathways.

This payment gap has particularly affected rural and underserved communities, where technology-supported care could serve as a lifeline for people with limited access to local specialists or who face transportation barriers to regular clinic visits.

The Innovation: Outcome-Aligned Payments

The ACCESS Model introduces a fundamentally different payment approach called Outcome-Aligned Payments (OAPs). Rather than paying for specific activities or the volume of services delivered, ACCESS provides recurring payments to participating organizations for managing patients’ qualifying conditions, with full payment contingent on achieving measurable health outcomes.

This outcome-focused methodology represents a philosophical shift. An ACCESS organization receives payment based on results—such as helping a hypertensive patient lower their blood pressure by 10 mmHg or helping a diabetic patient achieve better glycemic control—rather than on the number of visits conducted or devices prescribed. This structure gives clinicians and care teams the flexibility to design and deliver care in whatever ways work best for individual patients, whether through in-person visits, virtual consultations, asynchronous monitoring, or combinations of these modalities.

The model balances accountability with accessibility by basing payment on the overall share of an organization’s patients who meet their outcome targets, rather than requiring every individual patient to achieve their target. This recognizes the reality of clinical care: even with excellent programs, individual responses vary, and organizations should be rewarded for strong overall performance rather than penalized for the natural heterogeneity of patient outcomes.

Model Design and Structure

Clinical Tracks

ACCESS focuses on four clinical tracks, each grouping related conditions commonly treated with similar care approaches:

Early Cardio-Kidney-Metabolic (eCKM) Track: Addresses hypertension, dyslipidemia, obesity or overweight with markers of central obesity, and prediabetes—conditions where early intervention can prevent progression to more serious disease.

Cardio-Kidney-Metabolic (CKM) Track: Manages established diabetes, chronic kidney disease (stages 3a and 3b), and atherosclerotic cardiovascular disease, including heart disease.

Musculoskeletal (MSK) Track: Focuses on chronic musculoskeletal pain management.

Behavioral Health (BH) Track: Addresses depression and anxiety.

Each track includes guideline-informed, condition-specific measures and outcome targets, such as improvements in blood pressure, hemoglobin A1c, lipids, weight, or validated Patient Reported Outcome Measures (PROMs) for pain, mood, and function. Most tracks include an initial year of care followed by an optional continuation period at a reduced payment rate, supporting sustained patient engagement.

Comprehensive Care Services

ACCESS care organizations are expected to provide integrated, technology-supported care encompassing clinician consultations, lifestyle and behavioral support, therapy and counseling, patient education and care coordination, medication management, and ordering and interpreting diagnostic tests. Organizations may utilize FDA-authorized devices, software, and monitoring tools subject to appropriate regulatory oversight.

Robust Safety and Quality Safeguards

To ensure patient safety and care quality, ACCESS incorporates multiple layers of accountability. Participating organizations must:

• Enroll in Medicare Part B as providers or suppliers
• Designate a physician Clinical Director responsible for clinical oversight and compliance
• Comply with all applicable state licensure requirements
• Meet HIPAA privacy and security requirements
• Adhere to FDA requirements or be subject to FDA enforcement discretion

CMS will actively monitor clinical performance and may terminate organizations that fail to meet quality, safety, or outcome standards. Critically, CMS will publish aggregated, risk-adjusted outcomes data in a public directory, enabling patients and referring clinicians to make informed choices about which ACCESS organizations to work with.

Integration with Traditional Care

A key design principle of ACCESS is complementarity with existing primary care relationships. The model recognizes that technology-supported care should augment, not replace, traditional provider relationships. Primary care physicians and referring clinicians can refer patients to ACCESS organizations and receive regular electronic updates on patient progress through secure, interoperable systems.

To strengthen this collaboration, the model includes a new co-management payment that PCPs and referring clinicians can bill for documented review of patient updates and associated coordination activities, such as medication adjustments or problem list updates. This payment mechanism creates explicit incentives for care coordination and ensures that ACCESS organizations function as partners within patients’ broader care teams rather than as siloed services.

Promoting Access in Underserved Areas

Recognizing the particular value of technology-supported care for geographically isolated populations, ACCESS includes a fixed payment adjustment for rural patients in qualifying tracks. This adjustment acknowledges both the higher value of these services in areas with limited local care options and the potentially higher costs of reaching and serving rural populations.

Implementation Timeline and Market Response

The ACCESS Model will launch July 5, 2026, for organizations submitting applications by April 1, 2026. Applications received after this date will be considered for a January 1, 2027 start date. The model will run for 10 years, providing sufficient time to evaluate long-term outcomes and care sustainability.

Market response has been remarkably strong. More than 500 technology-enabled care organizations have submitted intent to apply, and leading medical societies have expressed support for CMS’s efforts. This enthusiasm reflects both the recognized inadequacy of current payment mechanisms and the confidence among innovative care organizations that they can succeed under outcome-based payment models.

Implications and Future Directions

The ACCESS Model represents more than an incremental payment reform; it signals a fundamental evolution in how Medicare conceptualizes value. By explicitly linking payment to measurable health improvements rather than service volume, ACCESS creates incentives aligned with what patients and the healthcare system ultimately care about: better health outcomes.

For patients, ACCESS promises expanded choice and improved access to modern care delivery methods that fit their lifestyles and preferences. For clinicians and care organizations, it offers payment flexibility to innovate and design care models optimized for patient outcomes rather than billing codes. For the Medicare program, it creates a pathway to evaluate whether outcome-focused payments can improve chronic disease management while controlling costs.

The model’s 10-year timeframe allows for rigorous evaluation of critical questions: Do outcome-aligned payments improve health outcomes compared to traditional care? Can technology-supported care reduce downstream healthcare utilization and costs? Does expanded access particularly benefit underserved populations? How do different care models and technologies perform across diverse patient populations?

CMS has indicated it may consider additional clinical tracks and conditions in future years, suggesting ACCESS could expand significantly if initial results are promising. The model’s voluntary nature—both for participating organizations and for patients—ensures that expansion will be driven by demonstrated value rather than mandate.

***

The ACCESS Model represents a thoughtful, ambitious attempt to align Medicare’s payment structures with 21st-century care delivery realities. By testing outcome-aligned payments for technology-supported chronic disease management, CMS is creating space for innovation while maintaining robust quality and safety standards. With strong market interest, broad clinical scope, and meaningful financial incentives for achieving health improvements, ACCESS has the potential to fundamentally reshape chronic care delivery for millions of Medicare beneficiaries. As the model launches in 2026, patients, clinicians, policymakers, and researchers will be watching closely to see whether this outcome-focused approach delivers on its promise of better health through expanded access to modern, technology-enabled care.

References

Centers for Medicare & Medicaid Services. (2025). ACCESS Model: Advancing Chronic Care with Effective, Scalable Solutions. Retrieved from https://www.cms.gov

Centers for Medicare & Medicaid Services. (2025). ACCESS Model Request for Applications. U.S. Department of Health and Human Services.

Centers for Medicare & Medicaid Services. (2025). ACCESS Model Detailed Frequently Asked Questions. U.S. Department of Health and Human Services.

Centers for Medicare & Medicaid Services. (2025). ACCESS Model Interest Form. Retrieved from https://www.cms.gov

U.S. Department of Health and Human Services. (1996). Health Insurance Portability and Accountability Act (HIPAA). Public Law 104-191.

Note: This analysis is based on publicly available CMS documentation regarding the ACCESS Model as of January 2025. Readers should consult current CMS resources for the most up-to-date information on participation requirements, application deadlines, and model specifications.