ACCESS Model: What Healthcare Organizations Need to Know

The ACCESS Model is a new CMS Innovation Center initiative designed to expand access to technology-supported chronic care in Original Medicare. By testing outcome-aligned payments, the model explores whether paying for measurable health improvement—rather than individual services—can better support people managing chronic conditions.

For healthcare organizations involved in chronic disease management, the ACCESS Model offers insight into how CMS is rethinking payment, accountability, and care delivery. Understanding how the model works can help organizations assess readiness and anticipate where Medicare policy is heading.

In this article, we’ll explain what the ACCESS Model is, why CMS developed it, and how healthcare organizations can interpret its implications.

What is the ACCESS Model?

The ACCESS Model—short for Advancing Chronic Care with Effective, Scalable Solutions—is a voluntary payment and care delivery model developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.¹

The model is designed to expand access to technology-supported care for people with chronic conditions by testing a new payment approach in Original Medicare. Rather than paying clinicians and care organizations based on individual services or activities, ACCESS uses Outcome-Aligned Payments, which tie reimbursement to measurable improvements in patients’ health.¹

ACCESS focuses on chronic conditions that affect a large portion of the Medicare population, including cardiometabolic, musculoskeletal, and behavioral health conditions. Participating organizations are responsible for managing patients’ qualifying conditions over time, using integrated care approaches that may include digital tools, remote support, and flexible care delivery methods.

The model will run for 10 years beginning July 5, 2026, and is intended to test whether paying for outcomes—rather than volume—can support better chronic disease management while preserving patient choice and strengthening accountability.¹

Why CMS is changing payment for chronic care

Chronic conditions affect more than two-thirds of people with Medicare and often require ongoing support that extends well beyond periodic office visits.¹ Conditions such as high blood pressure, diabetes, chronic musculoskeletal pain, and depression benefit from continuous monitoring, behavioral support, and timely intervention.

However, traditional fee-for-service payment in Original Medicare is tied to specific activities and encounters. This structure does not align well with technology-supported care models that deliver support asynchronously, remotely, or between visits.

The ACCESS Model is CMS’s response to this gap. By shifting payment toward outcomes rather than activities, CMS aims to expand access to modern approaches to chronic care while encouraging prevention, flexibility, and long-term health improvement.

How the ACCESS Model is designed

The ACCESS Model is intentionally designed to support flexibility in care delivery while maintaining accountability for patient outcomes. Rather than prescribing specific services or workflows, the model sets expectations around what care should achieve, allowing participating organizations to determine how best to deliver it.

Several design elements define how ACCESS operates:²

• Technology-supported care delivery: ACCESS is structured to support digital and hybrid care models, including telehealth, remote monitoring, mobile applications, and other tools that enable continuous support beyond traditional visits.

• Patient-centered enrollment and choice: Patients voluntarily enroll with participating organizations and retain all Original Medicare rights and benefits. CMS will maintain a public directory of ACCESS organizations and their risk-adjusted outcomes to support informed decision-making.

• Integration with traditional care: ACCESS is designed to complement existing care relationships. Primary care and referring clinicians can refer patients, receive regular progress updates, and bill a co-management payment for documented review and coordination activities.

• Transparency and accountability: CMS will publicly report aggregated, risk-adjusted outcomes, reinforcing accountability while allowing patients and clinicians to compare participating organizations.

Together, these design elements reflect CMS’s goal of expanding access to modern chronic care approaches while preserving patient choice, clinical oversight, and performance transparency.

How Outcome-Aligned Payments work

At the center of the ACCESS Model is a new payment approach called Outcome-Aligned Payments (OAPs).

Under ACCESS, participating organizations receive recurring payments for managing patients’ qualifying chronic conditions. Full payment is earned when patients demonstrate measurable improvement or control of their condition relative to their starting point—for example, lowering blood pressure, improving HbA1c levels, reducing pain, or improving mood.

Key features of Outcome-Aligned Payments include:²

• Payments are tied to health outcomes, not required services or visit volume

• Organizations have flexibility in how care is delivered, including in-person, virtual, or asynchronous approaches

• Performance is evaluated using condition-specific, guideline-informed measures

• Payment is based on the organization’s overall share of patients meeting outcome targets, rather than requiring every individual patient to meet their goal

This approach is intended to balance accountability with flexibility, recognizing that patients may respond differently to treatment while still rewarding strong overall performance.

The four clinical tracks

The ACCESS Model focuses on chronic conditions that affect a significant portion of the Medicare population. These conditions are organized into four clinical tracks, each grouping conditions that are commonly managed using similar types and levels of care:¹

• Early cardio-kidney-metabolic (eCKM) conditions: Hypertension, dyslipidemia, obesity or overweight with a marker of central obesity, and prediabetes.

• Cardio-kidney-metabolic (CKM) conditions: Diabetes, chronic kidney disease (stages 3a and 3b), and atherosclerotic cardiovascular disease.

• Musculoskeletal (MSK) conditions: Chronic musculoskeletal pain.

• Behavioral health (BH) conditions: Depression and anxiety.

Participating organizations are responsible for managing all qualifying conditions within a selected track, supporting integrated, patient-centered care. Outcome targets may include clinical biomarkers—such as blood pressure, HbA1c, lipids, or weight—as well as validated patient-reported outcome measures related to pain, mood, and function.

CMS has indicated that additional tracks and conditions may be considered in the future.

Requirements for participating in the ACCESS Model

Participation in the ACCESS Model is voluntary, but it includes defined requirements to support quality, accountability, and patient safety.

Participating organizations must:²

• Be enrolled in Medicare Part B as providers or suppliers

• Designate a Medicare-enrolled physician Medical Director responsible for clinical oversight and compliance

• Comply with applicable state licensure, HIPAA, and FDA requirements (or be subject to FDA enforcement discretion)

• Use secure, interoperable systems for patient enrollment, data exchange, and outcomes reporting

ACCESS organizations are expected to deliver integrated, technology-supported care that may include clinician consultations, lifestyle and behavioral support, therapy or counseling, patient education, medication management, diagnostic testing, and care coordination.

The model is designed to complement traditional care, not replace it. Primary care and referring clinicians may refer patients to ACCESS organizations, receive regular electronic updates on patient progress, and bill a new co-management payment for documented review and coordination activities.

Patients enroll voluntarily and retain all Original Medicare rights, benefits, and freedom to see any Medicare provider.

Operational implications for healthcare organizations

For healthcare organizations, the ACCESS Model has implications that extend beyond payment structure alone. Participation may influence how organizations approach chronic care delivery, outcomes tracking, and coordination across clinical and operational teams.

Outcomes measurement and reporting

Organizations must be prepared to track condition-specific outcomes over time using validated clinical and patient-reported measures, and to submit performance data in alignment with CMS requirements.

Technology and data infrastructure

ACCESS relies on the use of secure, interoperable systems to support patient enrollment, data exchange, remote monitoring, and outcomes reporting. Organizations may need to assess whether existing digital infrastructure can support these activities at scale.

Care model design

Because payment is tied to outcomes rather than activities, organizations have flexibility in how care is delivered—but must ensure that care models are structured to support measurable improvement across the full course of chronic condition management.

Clinical oversight and governance

Designation of a physician Medical Director and clear accountability for clinical quality and compliance are central to participation, requiring alignment across leadership, clinical teams, and operations.

Even for organizations that do not participate directly, these operational expectations may influence broader care delivery standards as outcome-based models continue to expand.

Example: how the ACCESS Model work in practice

Consider an organization participating in the ACCESS Model to support patients with chronic hypertension. Under traditional fee-for-service payment, care may rely primarily on periodic office visits, with limited support between encounters.

Under ACCESS, the organization could use a combination of clinician oversight, digital tools, and ongoing patient engagement to support blood pressure management over time. Patients might receive regular monitoring, education, and behavioral support, with care delivered in person, virtually, or asynchronously as appropriate.

The organization would track patient progress using guideline-informed measures and earn full payment based on the overall share of patients who achieve improvement or control relative to their baseline. Throughout the process, primary care clinicians would receive updates on patient progress and could bill a co-management payment for documented review and coordination activities.

In this scenario, ACCESS does not prescribe how care must be delivered. Instead, it sets outcome expectations while allowing flexibility in how organizations support patients’ health goals.

Why the ACCESS Model matters for healthcare organizations

The ACCESS Model reflects a broader CMS shift toward outcomes-based accountability in chronic care, particularly care supported by digital technologies.

For healthcare organizations, the model highlights several emerging priorities:

• Outcomes measurement is becoming central to Medicare payment

• Technology-supported care is moving into the Medicare mainstream

• Chronic care is increasingly evaluated over time, rather than visit by visit

• Transparency through public, risk-adjusted outcomes is becoming a standard expectation

Even organizations that do not participate directly may feel indirect effects as outcome-aligned care models influence payer expectations, partnerships, and care delivery standards.

By understanding the ACCESS Model, healthcare organizations can better assess readiness, identify gaps in care delivery and data infrastructure, and prepare for future CMS initiatives that emphasize value, prevention, and scalable chronic care innovation.

References

1. Centers for Medicare & Medicaid Services. (2026, January 12). ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model. U.S. Department of Health & Human Services. https://www.cms.gov/priorities/innovation/innovation-models/access

2. Centers for Medicare & Medicaid Services. (2026, February 4). ACCESS technical frequently asked questions. U.S. Department of Health & Human Services. https://www.cms.gov/priorities/innovation/access-technical-frequently-asked-questions

This content is for informational purposes only and does not constitute legal, financial, or regulatory guidance.