The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model tests an outcome-aligned payment approach in Original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage chronic disease. The voluntary model focuses on conditions affecting more than two-thirds of people with Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression. It will run for 10 years beginning July 1, 2026.
The ACCESS Model Request for Applications will be available soon. Complete the ACCESS Model Interest Form to be notified when the application becomes available. To be considered for the model’s first performance period beginning July 1, 2026, applications must be submitted by April 1, 2026. Applications received after this date will be considered for a January 1, 2027 start.
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Problem: Today, people with Original Medicare have limited access to technology-supported care services for managing their chronic conditions because of Medicare payment barriers.
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Solution: Through ACCESS, CMS will test a new payment option that emphasizes outcomes over activities, enabling clinicians to offer innovative technology-supported care that improves patients’ health and complements traditional care.
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Outcomes: Patients will have more options to help them meet their health goals, providers will gain new partners to help them co-manage their patients’ health, and Original Medicare will have a way to pay care organizations developing technology-supported services.
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Strategy: ACCESS supports disease prevention and health promotion by empowering people who have Medicare and clinicians with more choices.
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Model Details
Digital technologies are transforming the way care is delivered, helping people manage chronic conditions with continuous support beyond the doctor’s office. For example:
- Telehealth software helps patients interact with their health care providers from anywhere.
- Wearable devices continuously monitor sleep, heart rate, movement, blood sugar and other functions.
- Apps coach people to make lifestyle changes that can benefit both their behavioral and physical health.
Technology-supported care services can be especially valuable for people in communities with limited local care options, especially in rural areas.
Background
Original Medicare has historically lacked a payment option to adequately support novel technology-supported care. Fee-for-service methodologies pay for a defined set of activities that do not typically align with the way technology-supported care is delivered.
Innovation
The ACCESS Model will address this gap by testing Outcome-Aligned Payments (OAPs), a payment option for Medicare-enrolled care organizations. Participating organizations will receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes. The model focuses on clinical improvement or control of a condition based on each person’s starting point, for example, helping a patient with hypertension lower their blood pressure by 10 mmHg. By rewarding outcomes rather than defined activities (or volume of services delivered), ACCESS gives clinicians greater flexibility to deliver modern technology-supported care in ways that best improve patient health.
Goals
The ACCESS Model aims to:
- Empower people to achieve their health goals by improving patient access to new technology-supported care options to manage their chronic conditions.
- Expand clinicians’ ability to offer innovative, technology-enabled care through a straightforward payment pathway.
- Ensure that technology-supported care is clinician-guided, accountable, and coordinated.
- Promote transparency by publishing risk-adjusted health outcomes of technology-supported care so patients and referring clinicians can make informed choices.
Design
ACCESS care organizations are expected to offer integrated, technology-supported care that may include:
- Clinician consultations
- Lifestyle and behavioral support (nutrition, exercise, smoking cessation)
- Therapy and counseling
- Patient education and care coordination
- Medication management
- Ordering and interpreting diagnostic tests and imaging
- Use or monitoring of Food and Drug Administration (FDA)-authorized devices, including devices or software, or devices that are subject to FDA enforcement discretion
Care may be provided in-person, virtually, asynchronously, or through other technology-enabled methods as clinically appropriate.
To support safe and effective care, participating organizations must enroll in Medicare Part B as providers or suppliers and comply with applicable state licensure requirements and Health Insurance Portability and Accountability Act of 1996 (HIPAA) and FDA requirements (or otherwise be subject to FDA enforcement discretion). Organizations must also designate a physician Clinical Director responsible for clinical oversight and compliance. CMS will monitor clinical performance and publicly report aggregated, risk-adjusted results to help patients make informed choices.
ACCESS is designed to complement traditional care. PCPs and referring clinicians can refer patients to ACCESS organizations and will receive regular electronic updates on patient progress. PCPs and referring clinicians may also bill a new co-management payment for documented review of patient updates and associated coordination activities, such as medication adjustments or problem list updates, strengthening collaboration between ACCESS organizations and traditional providers.
ACCESS will focus on four clinical tracks addressing many of the most common chronic conditions:
- Early cardio-kidney-metabolic conditions (eCKM): hypertension (high blood pressure), dyslipidemia (high or abnormal lipids, including cholesterol), obesity or overweight with marker of central obesity, and prediabetes
- Cardio-kidney-metabolic conditions (CKM): diabetes, chronic kidney disease (3a or 3b), and atherosclerotic cardiovascular disease, including heart disease
- Musculoskeletal conditions (MSK): chronic musculoskeletal pain
- Behavioral health conditions (BH): depression and anxiety
CMS may consider additional tracks and conditions in the future.
Each track groups related conditions that are commonly treated using similar types and levels of care. Participating organizations are responsible for managing all qualifying conditions in a track, supporting integrated, patient-centered care. Each track includes a set of condition-specific measures and outcome targets informed by clinical guidelines—such as patient improvement or control in biomarkers like blood pressure, hemoglobin A1c (HbA1c), lipids, or weight, or in validated Patient Reported Outcome Measures (PROMs) of pain, mood and function.
Most tracks include an initial year of care followed by an optional continuation period at a reduced rate, facilitating continued patient support.
To promote access in underserved areas, a fixed adjustment will be applied to rural patients in qualifying tracks.
To balance accountability with model accessibility, CMS will base payment on the overall share of an organization’s patients who meet their outcome targets, allowing organizations to earn full payment through strong overall performance even if some individual patients do not meet their target. CMS will publish risk-adjusted outcomes, recognizing and rewarding excellent clinical performance.
Patients voluntarily sign up directly with participating ACCESS care organizations, either on their own or upon referral from their provider. To help patients and PCPs choose the most appropriate ACCESS organizations for their conditions, CMS will maintain a directory of all ACCESS participants including the conditions they treat and their risk-adjusted outcomes.
Patients with Original Medicare retain all of their rights, coverage, and benefits, including the freedom to see any Medicare health care provider.
https://www.cms.gov/priorities/innovation/innovation-models/access
