The Centers for Medicare and Medicaid Services launched the ACCESS Model on July 5, 2026, a voluntary ten-year program designed to test whether technology-supported care and outcome-aligned payment can improve chronic disease management. The initiative addresses a longstanding mismatch between how chronic illness care is delivered and how Medicare reimburses services, historically restricting payments to discrete office visits rather than ongoing monitoring and interventions.
The ACCESS Model focuses on four high-impact chronic conditions: high blood pressure, diabetes, chronic musculoskeletal pain, and depression. These conditions affect more than two-thirds of Medicare beneficiaries. Eligible participants include Medicare Part B-enrolled providers and suppliers, excluding certain categories like durable medical equipment and laboratory suppliers. Organizations must designate a Medicare-enrolled physician clinical director and demonstrate the ability to deliver technology-supported care for one or more qualifying conditions. First-phase applications required submission by April 1, 2026, with a subsequent phase beginning January 1, 2027 for applications submitted by October 1, 2026.
The model’s defining feature is outcome-aligned payments, or OAPs, which are recurring payments tied to whether patients experience measurable improvement in their health. Participating providers submit monthly claims; CMS pays 100% of the projected annual OAP amount in monthly installments for the first six months of the care period, then withholds payment for months seven through twelve. After the twelve-month period, CMS reconciles payment based on achievement of OAP measure targets, continuing annually throughout participation.
Technology is central to ACCESS, integrated into continuous care between clinical encounters rather than separately reimbursed. Participating organizations use technology to deliver clinician consultations, lifestyle support, behavioral health counseling, patient education, diagnostic testing, care coordination, and medication management—services historically difficult to sustain under traditional Medicare fee-for-service models. CMS designed the model to accommodate FDA-authorized devices and digital health technologies without tying payment to specific platforms, placing responsibility on organizations to determine how technology fits their care delivery strategy.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://natlawreview.com/article/access-model-technology-key-managing-chronic-conditions