CMS Launches ACCESS Outcome-Aligned Payment Model for High-Burden Chronic Conditions | iPharmaCenter

CMS has introduced the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, a new 10‑year voluntary payment model in Original Medicare designed to expand technology‑supported care for people living with chronic diseases. The first performance period begins July 1, 2026, with applications due by April 1, 2026; applications submitted after that date will be considered for a January 1, 2027 start.​

What is the ACCESS Model?

The ACCESS Model tests an outcome‑aligned payment approach that rewards organizations for helping Medicare beneficiaries prevent and manage chronic disease using scalable, tech‑enabled care solutions. By focusing on conditions that affect more than two‑thirds of people with Medicare, CMS aims to drive better control of blood pressure, glucose, pain, and mental health while reducing avoidable emergency department visits and hospitalizations.​

ACCESS will be organized into four clinical tracks that target some of the most prevalent and costly chronic conditions in Medicare. The early cardio‑kidney‑metabolic (eCKM) track will cover hypertension, dyslipidemia, obesity or overweight with central obesity, and prediabetes, while the cardio‑kidney‑metabolic (CKM) track will focus on diabetes, stage 3a/3b chronic kidney disease, and atherosclerotic cardiovascular disease, including heart disease. A musculoskeletal (MSK) track will address chronic musculoskeletal pain, and a behavioral health (BH) track will support beneficiaries with depression and anxiety, reflecting the strong links between mental and physical health in long‑term chronic disease management.​

Innovation: Outcome‑Aligned Payments

The ACCESS Model will address current gaps in chronic care by testing Outcome‑Aligned Payments (OAPs), a new payment option for Medicare‑enrolled care organizations. Participating organizations will receive recurring payments for managing patients’ qualifying conditions, but full payment will depend on achieving measurable health outcomes, such as helping a person with hypertension lower systolic blood pressure by a defined amount from their baseline. By rewarding outcomes rather than specific billable activities or service volume, ACCESS gives clinicians greater flexibility to use modern, technology‑supported tools and team‑based approaches in whatever way best improves patient health.​

Goals of the ACCESS Model

The ACCESS Model aims to empower people to reach their health goals by improving access to new technology‑supported care options for chronic condition management. It is also designed to expand clinicians’ ability to offer innovative, tech‑enabled care through a straightforward payment pathway, while ensuring that such care remains clinician‑guided, accountable, and coordinated across settings. In addition, ACCESS emphasizes transparency by publishing risk‑adjusted health outcomes for technology‑supported care, helping patients and referring clinicians compare options and make informed choices.​

Care delivery design and services

ACCESS care organizations are expected to provide integrated, technology‑supported services that can include clinician consultations, lifestyle and behavioral support (such as nutrition, exercise, and smoking cessation), therapy and counseling, and structured patient education and care coordination. Medication management, ordering and interpreting diagnostic tests and imaging, and the use or remote monitoring of FDA‑authorized devices or software (including certain devices under FDA enforcement discretion) are also in scope, enabling a comprehensive, data‑driven approach to chronic disease management.​

Why ACCESS matters for chronic care and next steps

Chronic conditions such as hypertension, diabetes, chronic pain, and depression account for the majority of morbidity, mortality, and spending in Medicare, and CMS is increasingly tying payment to quality and total cost of care for these populations. ACCESS builds on prior Innovation Center models and recent Medicare Physician Fee Schedule policies that emphasize remote monitoring, care coordination, and digital health tools as levers to improve outcomes at scale.