What You Need to Know
Key takeaway #1
Beginning in spring 2027, CMS will add four new condition tracks to itsAdvancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model — heart failure, COPD, substance use disorders, and tobacco cessation.
Key takeaway #2
Participation is voluntary for both Medicare beneficiaries and organizations. ACCESS applies only to traditional Medicare enrollees. However, some managed care organizations have pledged to align their own programs with the ACCESS outcomes-based payment model.
Key takeaway #3
CMS will maintain a public directory of participating organizations and covered conditions at Medicare.gov/ACCESS. The model runs for 10 years, and CMS will continue adding participating organizations throughout that period.
The Centers for Medicare and Medicaid Services (CMS) will add four condition tracks to its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model next spring, according to a September 15 announcement,to address gaps in chronic disease management between scheduled provider visits. The 10-year voluntary model officially launched on July 5, 2026. In its initial form, ACCESS targeted four high-prevalence conditions: high blood pressure, diabetes, chronic musculoskeletal pain, and depression. CMS reports that three out of four Medicare beneficiaries qualify for at least one existing ACCESS track. The new and expanded condition tracks are heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders (SUDs), and tobacco cessation. In addition, the existing chronic musculoskeletal pain track, which is currently limited to an initial 12-month period, will be extended for certain specified conditions.
Unlike the traditional fee-for-service payment model, ACCESS ties reimbursement to measurable health outcomes rather than the volume of inpidual services delivered. Participating organizations can offer a suite of between-visit interventions (e.g., virtual care, health coaching, remote patient monitoring, and connected devices or wearables)that are coordinated with a beneficiary’s existing care team. Primary care and other healthcare professionals can refer eligible Medicare beneficiaries to participating ACCESS organizations, which work alongside, rather than in place of, the patient’s existing providers.
The model is entirely voluntary. Beneficiaries who enroll in ACCESS retain full Medicare benefits, coverage, and freedom of provider choice.According to CMS, 18 clinical and patient societies have expressed support for the initiative. In addition, health plans covering 165 million Americans with Medicare Advantage, Medicaid, and private insurance have pledged to adopt an outcomes-based payment structure aligned to the ACCESS framework, using CMS implementation resources.
Potential Implications for Stakeholders
The ACCESS expansion carries near-term strategic and operational significance for a broad range of healthcare and life sciences clients:
- Hospitals and health systems should evaluate whether to pursue or expand participation in ACCESS. With 160 organizations currently enrolled, and CMS actively expanding the roster over a 10-year model period, early participation could position organizations to shape outcomes-measurement frameworks and capture outcomes-based revenue streams for high-volume chronic conditions.
- Physician groups and primary care practices will play a central referral role in the ACCESS ecosystem. Practices should assess their patient panels for beneficiaries who may qualify for the new SUD, heart failure, COPD, or tobacco-cessation tracks. They should consider workflows for identifying and referring eligible patients beginning in spring 2027.
- Digital health and medical device companies offering remote patient-monitoring technology, connected wearables, or artificial intelligence (AI)-enabled care platforms should evaluate ACCESS as a pathway to reimbursement and market adoption, particularly as CMS’s payment model rewards demonstrated outcomes rather than device utilization.
- Medicare Advantage plans and commercial insurers are not eligible for ACCESS, but the pledge by major payers to align with the outcomes-based payment structure signals a likely market-wide shift. Plan administrators should begin reviewing benefit design, network contracting, and value-based care arrangements in anticipation of market alignment.
- Behavioral health providers stand to benefit from the new SUD track, which integrates treatment for opioid, alcohol, and other disorders alongside co-occurring depression and anxiety management.
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