New CMS ACCESS Model Brings Outcome- and Value-Based Focus to Digital Health Management
In a significant move to modernize chronic care delivery, the Centers for Medicare & Medicaid Services (CMS) has announced the launch of the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. This new initiative is designed to expand the use of digital health technologies while shifting reimbursement toward measurable patient outcomes.
The ACCESS Model introduces Outcome-Aligned Payments (OAP), a structure in which providers receive fixed per-beneficiary payments tied directly to the achievement of defined clinical outcomes. This marks a clear transition from traditional fee-for-service models to value-based care.
Program Timeline and Participation
The model is scheduled to run from July 5, 2026, through June 30, 2036, with applications opening in 2026 and continuing on a rolling basis through early 2033. Providers seeking to join the first cohort, beginning July 2026, were required to submit applications by April 1, 2026.
Eligible participants include Medicare Part B-enrolled providers and suppliers, excluding Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers and laboratories. Notably, digital health companies that are not directly enrolled may participate through partnerships with eligible providers.
Target Population and Clinical Focus
The model is aimed at Original Medicare (fee-for-service) beneficiaries with qualifying chronic conditions categorized under four clinical tracks:
- Early Cardio-Kidney-Metabolic conditions
- Cardio-Kidney-Metabolic conditions
- Musculoskeletal disorders
- Behavioral health conditions such as depression and anxiety
Technology and Payment Structure
Participation requires the use of FDA-compliant digital health tools, including connected devices and software solutions, as well as technologies involved in the TEMPO Pilot.
Payment levels range from $90 to $420 annually per beneficiary, depending on the clinical track and other factors. Half of the payment is distributed monthly, while the remaining 50% is withheld and released at year-end based on performance. Providers can recover the full withheld amount if at least 50% of their patients meet the defined clinical outcome targets.
Operational Considerations
A key requirement of the ACCESS Model is that participating providers cannot bill Medicare Fee-for-Service (FFS) for beneficiaries during active care periods under the program. However, CMS has clarified that participants may still engage in other CMS initiatives, including upcoming models such as LEAD.
Additionally, CMS is evaluating a temporary policy to exclude ACCESS-related spending from accountable care organization (ACO) financial benchmarks during the program’s first year, with plans to incorporate these costs into broader total cost-of-care calculations in subsequent years.
Strategic Impact
The ACCESS Model represents a major step in CMS’s broader strategy to integrate digital health into routine care while aligning financial incentives with patient outcomes. By emphasizing measurable improvements in chronic disease management, the initiative is expected to accelerate innovation and improve long-term care quality for Medicare beneficiaries.
