The Center for Medicare & Medicaid Services (CMS) continues to refine its approach to improving quality and outcomes in healthcare delivery, placing a growing emphasis on supporting innovative and evidence-based treatments. The Department of Health and Human Services has identified addressing chronic disease as a central priority of the Trump Administration, a focus reflected in two recently released Center for Medicare & Medicaid Innovation (CMMI) models.
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model will test Outcome Aligned Payments (OAPs) to determine whether technology-enabled chronic care reduces Medicare expenditures while preserving or enhancing quality.
As Annie Tuttle has previously written, the voluntary ACCESS model focuses on chronic conditions—including hypertension, diabetes, chronic musculoskeletal pain, and depression—and ties recurring payments directly to achieving patient-level and population-level outcomes. CMS has released payment amounts and performance targets, and applications will be accepted through 2033.
The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model is a voluntary model that evaluates whole-person, functional, and lifestyle medicine interventions intended to complement existing Medicare fee-for-service (FFS) care. Participation requires incorporating nutrition or physical activity components to support behavioral changes. CMS has signaled interest in proposals addressing conditions such as dementia, diabetes, cardiovascular disease, obesity, chronic pain, chronic obstructive pulmonary disease, and heart failure, as well as anxiety and depression.
While innovation in coverage policy is not new, the ACCESS and MAHA ELEVATE models, with their focus on treatment of chronic disease, supporting innovation, and generating evidence, illustrate CMS’s evolving CMS coverage evidence strategy.
Treatment of Chronic Diseases
ACCESS and MAHA ELEVATE both aim to address chronic disease but emphasize different aspects of care.
ACCESS prioritizes chronic conditions like those targeted by MAHA ELEVATE such as cardiovascular disease, chronic musculoskeletal pain, diabetes, kidney disease, anxiety, and depression. However, the CMMI model concentrates on ongoing management of chronic conditions through technology-supported care, such as:
- Clinical consultations
- Lifestyle and behavioral support
- Therapy and counseling
- Patient education and care coordination
- Medication management
- Ordering and interpreting diagnostic tests and imaging
- Use or monitoring of Food and Drug Administration (FDA)-authorized devices
ACCESS will be based on four clinical tracks that have a set of condition-specific outcome targets including, 1) Early cardio-kidney-metabolic conditions (eCKM), 2) Cardio-kidney-metabolic conditions (CKM), 3) Musculoskeletal conditions (MSK), and 4) Behavioral health conditions (BH). Most tracks include an initial year of care followed by an optional continuation period at a reduced rate, to facilitate continued patient support.
MAHA ELEVATE, by contrast, focuses on evaluating whole-person and lifestyle-based approaches intended to influence long-term behavior, improve daily functioning, and support healthier living, which could include but is not specific to digital technologies. While it overlaps with ACCESS in several conditions, it includes additional emphasis on dementia, obesity, and whole-person interventions that address root causes of chronic disease.
MAHA ELEVATE-funded cooperative agreements will use evidence-based approaches that promote healthy lifestyles and are not intended to provide primary or sole treatment, but rather to add practices that contribute to healthier living. The model aims to use novel approaches to prevent illness and promote wellness, supporting behavior changes focused on slowing and/or reversing disease progression.
Supporting Innovation
Another key distinction lies in how each model supports innovation.
ACCESS seeks to modernize the FFS payment landscape for chronic care by replacing activity-based reimbursement with outcomes-based payments. This structure is intended to evaluate whether aligning payment with outcomes can support scalable, technology-enabled chronic care. Outcomes will be assessed relative to each patient’s starting point. Participating organizations will receive recurring per‑beneficiary payments contingent on meeting clinical and patient-reported outcome thresholds. OAPs will be adjusted for the overall share of patients who meet the organization’s intended outcome targets, to balance accountability with model accessibility. Outcome rewards are intended to further enable providers to deliver modern technology-supported care that best improves patient health.
MAHA ELEVATE supports innovation by funding cooperative agreements that test whole-person, lifestyle-focused interventions not currently covered under FFS Medicare. CMMI will fund up to 30 cooperative agreements across two implementation cohorts beginning in 2026 and 2027, with a total budget of approximately $100 million over a 3-year performance period. Rather than altering FFS payment, the model evaluates the effectiveness of these interventions in complementing beneficiaries’ existing care. Applicant organizations with experience integrating and measuring the impact of evidence-based, chosen approaches will be considered for cooperative agreements.
Generating Evidence
Together, ACCESS and MAHA ELEVATE reflect CMS’s growing interest in evaluating alternative strategies for care delivery outside traditional FFS. Both are voluntary models that rely on structured evidence generation, ACCESS through performance‑linked payment data and MAHA ELEVATE through funded cooperative agreements.
For the ACCESS model, CMS will publish risk-adjusted outcomes, recognizing and rewarding excellent clinical performance. ACCESS model participants will submit required data through secure, interoperable systems to register patients, share clinical data, track outcomes, and coordinate care with a beneficiary care team. Outcomes and progress will be continuously monitored by CMS to ensure patient safety and proper adherence to guidelines as well as used to determine OAPs.
MAHA ELEVATE requires organizations in cooperative agreements to create a plan for data collection, quality measurement, recruitment and cost containment. Additional details regarding evidence generation for MAHA ELEVATE are specific to cooperative agreements and have not yet been published.
What’s Ahead for ACCESS and MAHA ELEVATE
ACCESS will run from July 5, 2026, through June 30, 2036. CMS is accepting applications on a rolling basis through April 1, 2033. Applications for the first cohort are due April 1, 2026; applications received afterward are eligible for a January 1, 2027, start. CMS has also released the payment amounts and performance targets for the model.
MAHA ELEVATE will be implemented in two cohorts beginning September 1, 2026, and again in 2027. The first cohort Notice of Funding Opportunity (NOFO) and Request for Application (RFA) are expected to be released in early 2026.
As CMS continues publishing updates, both models will provide new insights into how evidence can be generated through outcomes‑linked payment structures (ACCESS) or lifestyle‑based interventions (MAHA ELEVATE).
Research support for this article was provided by Jasmine Garner, Health Policy Intern.