The Center for Medicare and Medicaid Innovation (CMMI) has announced a voluntary, 10-year Medicare payment and service delivery model called Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, designed to test whether a new payment methodology can better support technology-enabled care, improve health outcomes, and lower overall Medicare spending for high-cost chronic conditions. The ACCESS Model will focus on chronic conditions including high blood pressure, diabetes, chronic musculoskeletal pain, and depression, which affect more than two-thirds of people enrolled in Medicare.
Payment Structure and Conditions
The ACCESS Model uses a new payment methodology called Outcome Aligned Payments (OAPs), which provides regular payment to fund certain activities with additional earned financial incentives based on clinical improvement or control of a condition. Participants will receive recurring payments for managing patients’ qualifying conditions, but full payment will be reserved for achievement of measurable health outcomes goals such as lowering a patient’s blood pressure by 10mmHg.
The model will launch with four clinical tracks: early cardio-kidney-metabolic conditions (eCKM) covering hypertension, dyslipidemia, obesity or overweight, and prediabetes; cardio-kidney-metabolic conditions (CKM) including diabetes, chronic kidney disease (3a or 3b), and atherosclerotic cardiovascular disease; musculoskeletal conditions addressing chronic musculoskeletal pain; and behavioral health conditions treating depression and anxiety.
Service Delivery and Participation
ACCESS Model participants may furnish technology-supported care delivered either in-person or virtually, including clinician consultations, lifestyle and behavioral support such as nutrition and exercise counseling, therapy and counseling, patient education and care coordination, medication management, diagnostic testing, and monitoring of FDA-authorized devices. Participants must integrate technology-enabled care supporting continuous, proactive chronic condition management. The model is designed to integrate with patients’ existing care teams or other value-based models such as the Medicare Shared Savings Program.
The ACCESS Model is scheduled to begin on July 1, 2026, with applications due by April 1, 2026. Medicare-participating entities interested in becoming ACCESS Partner Organizations must designate a medical director responsible for clinical oversight and compliance and comply with applicable state licensure requirements, HIPAA, and FDA requirements. Participants must meet rigorous data reporting requirements and transmit outcome measure data via standardized APIs.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://natlawreview.com/article/access-model-cmmis-new-technology-enabled-chronic-care-model