The Centers for Medicare & Medicaid Services (CMS) has announced one of its most significant chronic care initiatives in years: the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions). Designed to transform how chronic conditions are managed under Original Medicare, ACCESS represents a shift toward outcome‑aligned reimbursement that supports technology‑enabled care rather than traditional fee‑for‑service billing.  

Why ACCESS Matters 

For decades, Medicare’s reimbursement system has largely tied provider payment to specific activities such as procedural billing codes, time‑based interactions, or device supplies; a model that often fails to accommodate modern, technology‑driven chronic care delivery. The ACCESS Model aims to address this gap by testing Outcome‑Aligned Payments (OAPs), where payment is linked to meaningful improvements in health outcomes rather than the volume of services provided.  

Traditional fee‑for‑service billing under Original Medicare typically compensates providers based on individual encounters, tests, or monitoring events. In contrast, ACCESS introduces predictability and flexibility by rewarding organizations that achieve measurable health improvements such as better blood pressure control or reduced pain for patients with chronic conditions.  

Structure and Timeline of ACCESS 

The ACCESS Model is being launched as a voluntary 10‑year demonstration project under the CMS Innovation Center. It will begin on July 5, 2026 and run through June 30, 2036, with multiple application cycles planned through 2033. Organizations interested in participating must apply in advance. Initial application deadlines for the first performance period typically occur months before implementation.  

Participation is open to Medicare Part B–enrolled providers and suppliers (excluding Durable Medical Equipment and laboratory suppliers) interested in implementing innovative, technology‑supported care for patients with specific chronic conditions. Participating organizations will designate a clinical director responsible for quality and compliance, and they must meet traditional Medicare enrollment criteria. 

Outcome‑Aligned Payments (OAPs): The Core Innovation 

At the heart of the ACCESS Model is its payment methodology. Rather than billing per service or device, participants receive recurring fixed payments for managing a patient’s qualifying condition, with the full payment contingent on achieving measurable outcome targets. This approach reflects broader value‑based care principles and represents a notable departure from Medicare’s historical billing structure.  

ACCESS’s Outcome‑Aligned Payments work as follows: 

• Participants receive predetermined payments for each beneficiary enrolled under a clinical track over a 12‑month period. 

• Payments are contingent upon patients reaching defined clinical goals, such as improved blood pressure, stabilized weight, or measurable reductions in symptoms. 

• Organizations are responsible for coordinating and delivering the care needed to help patients achieve these outcomes, using technology, allied health teams, and data‑driven tools.  

This payment approach stands in contrast to traditional Medicare, where reimbursement is strictly tied to service counts and codes such as CPT codes for specific interactions and not directly linked to long‑term clinical improvements. 

Who and What ACCESS Covers 

ACCESS initially focuses on four clinical tracks that reflect conditions prevalent among people with Medicare and that significantly drive chronic morbidity: 

• Early Cardio‑Kidney‑Metabolic (eCKM): Hypertension, dyslipidemia, obesity or overweight with central obesity, and prediabetes. 

• Cardio‑Kidney‑Metabolic (CKM): Diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease, including heart disease. 

• Musculoskeletal (MSK): Chronic musculoskeletal pain lasting longer than three months. 

• Behavioral Health (BH): Conditions including depression and anxiety.  

These four tracks were chosen because they represent conditions that affect more than two‑thirds of Medicare beneficiaries, demonstrating the breadth of chronic disease management needs across the aging population. 

Participants are expected to provide integrated care tailored to each track, including clinician consultations, behavior and lifestyle support, care coordination, medication management, patient education, and the use of FDA‑authorized devices or software when appropriate. Care may be delivered in‑person, virtually, or through asynchronous means, offering significant flexibility in care design.  

Implications for Providers and Patients 

ACCESS represents a significant evolution in how Medicare envisions chronic care delivery. For providers, the model offers: 

• Predictable, recurring payments tied to outcomes, reducing reliance on conventional activity‑based billing. 

• Flexibility to integrate technology, digital tools, and multi‑disciplinary care coordination into chronic disease management. 

• Greater opportunity to partner with tech vendors and lower administrative burden through incentive‑aligned reimbursement. (CMS) 

Patients benefit because ACCESS prioritizes measurable health improvements, which encourages proactive management of conditions rather than episodic responses to symptoms. The model’s emphasis on preventing disease progression. complements traditional care relationships and may help improve quality of life over the long term.  

To support organizations and vendors, CMS is developing an ACCESS Tools Directory, where technology solutions that facilitate model compliance and success can be listed. This directory aims to connect participants with essential digital health platforms, monitoring devices, analytics tools, and interoperable systems that enable outcome measurement and care coordination.  

Challenges and Future Outlook 

While ACCESS promises to modernize chronic care, it also introduces new demands: 

• Organizations must build robust infrastructure to track outcomes, share data securely with providers, and demonstrate adherence to clinical and privacy standards. 

• CMS evaluations of the model will determine whether it should be expanded or made permanent; success will hinge on whether measurable outcomes improve without increasing overall Medicare costs.  

ACCESS could pave the way for similar payment innovations across Medicare Advantage plans, Medicaid, and commercial payers if it demonstrates that outcome‑aligned payments can be both affordable and clinically effective. Its emphasis on technology, interoperability, and measurable progress reflects broader trends in value‑based care.  

Conclusion 

The CMS ACCESS Model represents a transformation in how chronic disease management is reimbursed in Medicare from a volume‑based, activity‑centered system to one that rewards measurable health outcomes with technology‑enabled solutions. By tying payment to results and empowering clinicians to innovate, ACCESS aims to break longstanding barriers to care access, support personalized treatment, and improve long‑term health outcomes for millions of people with Medicare. 

As the model rolls out beginning in mid‑2026, providers, technology vendors, and chronic care stakeholders must prepare for this shift toward outcome‑aligned care; a change that could define the future of chronic care delivery in the U.S. health system.