CMS Expands Medicare ACCESS Chronic Care Model

Medicare’s ACCESS chronic-care model will add four new condition tracks next spring, doubling down on its effort to tie payments to patient outcomes rather than volume of care.

The Advancing Chronic Care with Effective, Scalable Solutions, or ACCESS, voluntary model is designed to give Medicare beneficiaries more options for managing chronic conditions outside traditional office visits through virtual care, health coaching, remote monitoring, connected devices and wearable technology. CMS says the model will cover conditions affecting roughly three in four Medicare beneficiaries once the new tracks are added.

The payment structure is intended to distinguish ACCESS from traditional fee-for-service Medicare. Participating organizations receive recurring payments for managing patients with four qualifying conditions, with payment tied to measurable improvements in health rather than individual services.

CMS describes the approach as “Outcome-Aligned Payments.”

The Centers for Medicare & Medicaid Services (CMS) will revise the ACCESS model on April 1, 2027 and participating providers can begin offering technology-supported care for another four qualifying conditions:

1. Heart failure
2. Chronic obstructive pulmonary disease
3. Substance use disorder
4. Tobacco cessation

CMS also will provide longer-term support for certain patients with chronic musculoskeletal conditions after the initial care period. The voluntary 10-year model launched in July with four clinical tracks:

1. Early cardio-kidney-metabolic conditions (including hypertension and pre-diabetes)
2. Cardio-kidney-metabolic conditions (diabetes and chronic kidney disease)
3. Chronic musculoskeletal pain
4. Behavioral health conditions (including depression and anxiety)

Health and Human Services Secretary Robert F. Kennedy Jr. told Medical Economics the model is intended to change incentives in chronic disease care.

When we pay for activity instead of outcomes, we get more activity. We do not necessarily get healthier patients.

STAT reported that the model is still in its early stages, but the additional four conditions could benefit from technology-supported management. The publication covered the announcement reporting that during the event, CMS Chief AI & Technology Officer Jacob Shiff said 17 major health plans covering 165 million people have committed to adopting ACCESS-aligned payment approaches.

• UnitedHealthcare
• Humana
• Cigna
• Centene
• Devoted Health
• CVS Health
• Assorted Blue Cross Blue Shield Plans

The agency also released a directory of participating providers, giving Medicare beneficiaries and clinicians a way to identify organizations offering ACCESS services. Patients with Original Medicare can voluntarily enroll with participating organizations or be referred by their healthcare providers. Medicare Advantage beneficiaries are not eligible for ACCESS, although their plans may offer similar programs.

The expansion also has implications for rural health, where CMS says technology-supported care can provide additional options for people living in communities with limited access to local providers. The agency has said rural patients in qualifying tracks will receive an adjustment intended to promote access to the model.

A report from Inside Health Policy quoted Georgia’s Medicaid director and president of the National Association of Medicaid Directors, Stuart Portman. Portman said,

The model’s focus on measurable results could complement broader federal investments in technology and rural health. The ability to have a model that says ‘let’s be outcomes oriented’ is great.