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On December 1, the Centers for Medicare & Medicaid Services (CMS) announced the Advancing Chronic Care with Effective, Scalable Solutions Model (ACCESS), a 10-year voluntary alternative payment model (APM) that will pay participating organizations recurring, outcome-aligned payments for providing technology-supported care to manage common chronic conditions.
The announcement leaves undefined major details, including the amount and frequency of the payments, the degree of risk participants will bear, and the technology use requirements. Still, ACCESS has the potential to be a substantial model. The covered chronic conditions affect two-thirds of Medicare beneficiaries, and the announcement describes a flexible model that includes a variety of activities. Whether it lives up to its potential will depend on outstanding details, which CMS expects to publish soon in the request for applications and through additional guidance.
Overview of ACCESS
ACCESS is a product of the Center for Medicare and Medicaid Innovation (Innovation Center) that aims to promote evidence-based preventive care and management of costly conditions, empower patients to achieve their health goals, and enhance patient choice. The model will run from July 2026 through June 2037. CMS will begin accepting applications for ACCESS on January 12, 2026 (with an initial deadline of April 1 for the model's first performance period beginning July 1) and will continue accepting applications on a rolling basis for subsequent performance periods.
To participate in ACCESS, organizations must be enrolled in Medicare Part B, meet standard Medicare participation requirements, complete an application, and designate a physician clinical director to be responsible for care quality and compliance.
ACCESS participants will receive recurring payments for delivering technology-supported care, such as therapy through telehealth, nutritional coaching through a digital app, or heart rate monitoring through a wearable device. The amount Medicare pays an ACCESS participant will depend on the extent to which the participant achieves defined, measurable outcomes for its patients with the chronic condition.
ACCESS is designed to complement traditional care by supporting care coordination with primary care and other clinicians. ACCESS participants must share care plans and updates with referring clinicians through secure electronic exchanges. To incentivize collaboration among clinicians and ACCESS participants, clinicians can bill a new co-management code for reviewing patient updates and associated care coordination, such as adjusting medication and updating problem lists. Payment for co-management will be up to approximately $100 per year, per beneficiary, per track.
The model will initially focus on four broad clinical tracks—early cardio-kidney-metabolic (eCKM) conditions, cardio-kidney-metabolic (CKM) conditions, musculoskeletal (MSK) conditions, and behavioral health (BH) conditions—with the possibility of additional tracks in the future.
| Track | Qualifying Conditions | Outcome-Aligned Payment Measure |
|---|---|---|
| eCKM | Hypertension, dyslipidemia (e.g., high cholesterol), obesity or overweight with marker of central obesity, and prediabetes | -Control or improvement in blood pressure, lipids, weight, and hemoglobin A1c |
| CKM | Diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease, including heart disease | -Control or improvement in blood pressure, lipids,
weight, and hemoglobin A1c
-Chronic kidney disease and diabetes only: Submission of estimated glomerular filtration rate and urine albumin-creatinine ratio data |
| MSK | Chronic musculoskeletal pain | -Improvement in pain intensity, interference, and overall function (assessed via a validated patient-reported outcome measure) |
| BH | Depression and anxiety | -Improvement in symptoms (assessed via Patient
Health Questionnaire (PHQ-9) for depression and Generalized Anxiety
Disorder (GAD)-7 for anxiety)
-Submission of WHODAS 2.0 12-item, a validated patient-reported outcome measure of overall function |
Medicare beneficiaries can sign up directly with ACCESS participants, or clinicians can refer them to ACCESS participants. To help patients and clinicians choose the most appropriate ACCESS organizations, Medicare will maintain a public directory of ACCESS participants, including the conditions they treat and their risk-adjusted clinical outcomes.
Takeaways
ACCESS will create new opportunities for healthcare providers, technology companies, and population health-focused organizations to be paid for managing, or providing the tools to manage, chronic conditions that affect two-thirds of Medicare beneficiaries. The extent to which it creates these opportunities will be determined by key details that remain undefined.
More broadly, ACCESS is one of several recent Innovation Center models aimed at improving outcomes for costly conditions through more effective care management and coordination. Unlike other recent Innovation Center models (such as the Transforming Episode Accountability Model (TEAM) and the Ambulatory Specialty Model (ASM)), ACCESS is voluntary. Its voluntary nature could limit the number of participants, and it could pose the self-selection problem that, in part, led the Innovation Center to make TEAM and ASM mandatory.
On the other hand, ACCESS has the potential to attract a substantial number of participants at varying stages of participation in APMs, from those who do not participate in APMs and are paid only on a fee-for-service (FFS) basis to those who participate in accountable care organizations (ACOs) and other advanced APMs and take on financial risk. Outside of ACCESS, providers are generally not paid on an FFS basis for successfully managing chronic conditions. Instead, they are generally paid, if at all, only in a manner that is indirect and spread across broader populations, such as through ACO shared savings or similar mechanisms in existing APMs. But, with ACCESS, providers will be paid more directly for successfully managing chronic conditions through the outcome-aligned payments and co-management payments. These new payments could not only increase the number of providers who use technology to manage chronic conditions, but they could also encourage additional investment in value-based care delivery systems by those who already provide these services.
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