CMS’s ACCESS Model expansion adds chronic care tracks for Medicare providers

CMS continues to put weight behind the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a 10-year initiative to apply value-based payment and digital solutions to chronic disease management.

The agency announced Sept. 15 that it would add to the services covered under the model. Newly covered conditions effective April 1, 2027, are set to include heart failure, chronic obstructive pulmonary disease, substance use disorders and tobacco cessation. With the updates, three-quarters of Medicare fee-for-service beneficiaries are expected to qualify for ACCESS.

The new tracks will join the four that were part of the model launch: early cardio-kidney-metabolic, cardio-kidney-metabolic, musculoskeletal and behavioral health. Another change will bring a follow-on track for chronic musculoskeletal pain beyond the initial 12-month ACCESS care period per patient.  

How the ACCESS Model ties payment to outcomes

CMS wants ACCESS to serve as an outcomes-based, virtual chronic-care model that formally brings tech-enabled vendors into Medicare’s delivery architecture. There were 160 healthcare technology companies participating when the model kicked off in July, and companies can join on a rolling basis throughout the first seven years of the model’s decade-long run.

Payments to companies range from roughly $180 per patient for conditions that fall in the musculoskeletal and behavioral tracks to as much as $420 for cardiometabolic conditions. CMS pays the Medicare portion of the outcome-aligned reimbursement through monthly claims, with payments during the care period capped at 50% of the annual amount. The remaining 50% is withheld and reconciled after the 12-month period based on clinical outcomes and other adjustments.

Some companies in ACCESS may drop out due to the relatively low payment rates, said Ashul Govil, MD, a cardiologist with ACCESS participant Story Health.

In other value-based payment pilots, CMS has tended to offer relatively generous reimbursement in early years before scaling back in subsequent years. ACCESS lacks the same type of runway, Govil said in a May 2026 interview.

“Those few who truly can innovate, those few who can actually figure out how to use the technology AI, but also mix in the appropriate human resources when needed to deliver this kind of care in a cost-effective way, I think that’s going to really help,” Govil said. “And another thing, it helps us discover: Where are the [payment] limits in delivering care? Maybe these numbers are too low. I think CMS will be able to also determine that.”

Tight payment rates put efficiency at the center

The tight margins inherent in the payment model spur innovation, pushing vendors to deploy automation, AI and efficient workflows, said Patrick Sheehan, vice president for value-based care with Withings, a healthcare tech company participating in ACCESS.

“We think it’s a forcing function in remote management,” Sheehan said in May.

CMS estimates significant Medicare savings from ACCESS, including roughly $362 million in musculoskeletal (MSK) care. Those savings could be linked in large part to the earlier, guided treatment that’s expected to emerge, Albert Katz, MBA, co-founder of Flagler Health, an AI-enabled infrastructure and operating system for MSK clinics, said during a September webinar.

Co-management payments create a role for traditional providers

Accountable care organizations and referring providers receive a co-management fee of $30 per patient service, plus a $10 initial onboarding modifier. The annual cap on the fee is $100 per patient per year. No patient cost-sharing is permitted on the co-management payment.

While such revenue may not amount to much, providers can use the model to trigger key improvements.

“The entire point of ACCESS is to improve the quality scores of your patients and to reduce the total cost that essentially you’re incurring via poor morbidity of your patients, whether it’s going to the right physician or just not doing the extra steps that are necessary post-treatment,” Katz said during the webinar hosted by VBC Exhibit Hall.

Value drivers for Medicare, said Sheehan, include reductions in ED visits and Part A utilization over what he expects to be a three-year ROI window.

ACCESS can extend health system chronic care capacity

ACCESS is philosophically aligned with serving lower-acuity, long-horizon populations. Companies should strive to operate as a virtual specialist or extension of the health system, managing routine remote monitoring and looping patients back to systems for acute or procedural needs, Govil said.

“We can’t, virtually, do everything that the patients will need, and so it’s appropriate for us to partner with those who can provide the advanced care, and then we help offload some of the patient volume and some of the needs that patients have, get them to the appropriate goals that we can manage virtually or remotely, and in between those visits,” Govil said.

With respect to cardiovascular and cardiometabolic disease management, he said, ACCESS is a natural extension of long-running quality-based initiatives.

“It aligns well with [medical] society guidelines in terms of appropriate patient care, but also a lot of quality-care and value-based care metrics, whether it’s HEDIS [Healthcare Effectiveness Data and Information Set] or things that go into [Medicare] star ratings,” Govil said. “A lot of the provider groups and health systems that we work with have already been shooting for some of these outcomes.”

Health systems can take advantage of ACCESS

For traditional providers, strategies can entail using ACCESS vendors to divert some of their chronic disease management volume while retaining attribution and higher-complexity in-person work, Govil said.

“As a primary care provider, I don’t have to focus on their blood pressure, their cholesterol, their diabetes, their obesity as much,” he said. “I can mention that and then refer to [an ACCESS participant] where [they] can really help manage the medications and the outcomes for that piece, and maybe I can instead focus on the fact that because of diabetes, they have a wound on the bottom of their foot, and I can inspect that and treat that. It’s almost like we can work as a partner to help offload a portion of care and make that time that they do have in the clinic more effective.”

Getting started can entail merely touching base with a participating vendor, Katz said during the webinar.

“That vendor will essentially just need to speak to your IT person,” he said. “That will give them access to the EHR, and then the model just begins. You can either just send a sheet out to all your physicians to make the recommendation to ACCESS for every patient, or a lot of ACCESS solutions today can also just triage those patients and essentially [have the physician] re-sign an order form every month.”