When the Centers for Medicare & Medicaid Services’ (CMS’s) Innovation Center (CMMI) announced the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model in December, the framing echoed the familiar aspirations of all CMMI models: better patient outcomes and lower Medicare costs. Yet beneath that familiar mission statement, ACCESS signals something more distinct. The model is designed to test whether Medicare can pay for technology-enabled chronic care while allowing providers flexibility in how care is delivered.

The significance of ACCESS lies in how CMS proposes to pursue those goals. Rather than layering additional billing codes onto fee-for-service Medicare, the model introduces an outcome-aligned payment methodology designed to support technology-enabled chronic care across a defined set of conditions rather than controlling the provider activities.

A voluntary 10-year initiative with multiple cohorts, ACCESS will begin with the first cohort of participants in July. The model applies to conditions affecting more than two-thirds of Medicare beneficiaries, including chronic musculoskeletal pain, cardio-kidney-metabolic conditions such as hypertension and diabetes, and behavioral health conditions, including depression, and is intended to support more continuous, proactive approaches to care.

Rather than centering payment on discrete technologies or prescribing specific care models, CMMI is testing whether Medicare can reward measurable clinical improvement while leaving decisions about care delivery activities to participating organizations. If successful, ACCESS could establish a durable framework for integrating digital health and remote care into Original Medicare, without requiring providers to assume full global risk or locking CMS into particular technologies.

Why ACCESS, and Why Now?

ACCESS is launching as the Trump administration elevates chronic disease through its Make America Healthy Again initiatives, while also seeking to address healthcare spending growth and Medicare’s long-term affordability.

At a December 4 CMS event, Modernizing America’s Care for Better Health, CMS Administrator Dr. Mehmet Oz pointed to projections showing healthcare spending rising faster than overall economic growth, noting the pressure such trends place on Medicare and the broader health system.

“It fundamentally comes down to our ability to empower patients with better information and incentivize providers,” Oz said. “We believe [that will] allow the health economy to grow at a rate similar to the GDP, rather than twice that rate.”

ACCESS’s focus on outcomes, rather than service volume, addresses gaps in Medicare payment for tools that improve chronic disease management—such as remote monitoring and digital support—which often do not fit well within existing codes.

ACCESS reflects a different policy approach: that CMS can define what clinical success looks like and align payment accordingly, while giving providers and partner organizations the flexibility to determine how best to achieve those outcomes.

ACCESS Focuses on Four Beneficiary Tracks for Outcomes

The ACCESS model introduces outcome-aligned payment (OAP), providing quarterly standard per-patient payments for managing chronic conditions. Payment depends on achieving improvement or control compared to individual patient baselines, aiming to incentivize measurable progress.

Unlike accountable care organizations or total cost-of-care models, ACCESS does not require participants to assume responsibility for all Medicare spending associated with a beneficiary. Instead, organizations are accountable for outcomes within selected clinical tracks. Reflecting both disease burden and the availability of measurable endpoints, CMS has organized ACCESS around four tracks: early cardio-kidney-metabolic, later cardio-kidney-metabolic, musculoskeletal, and behavioral health.

In an interview with the American Medical Association, Abe Sutton, CMMI  Director and deputy administrator for CMS, emphasized that this structure is intentional.

“What this model is focused on is how we can leverage new approaches to care for patients and reward the delivery of care that drives better outcomes,” Sutton said.

By separating accountability for outcomes from responsibility for the total cost of care, Sutton explained, ACCESS is designed to give providers room to innovate without requiring them to take on risk beyond the conditions they are actively managing.

Provider Flexibility and Provider Responsibility

ACCESS grants broad latitude in care delivery, focusing payment on measured patient improvement, not specific technologies, methods, or activities. In doing so, CMS prioritizes outcomes and stimulates provider innovation.

That flexibility is paired with meaningful responsibility. Payments are tied to performance across an organization’s patient panel, and CMS has indicated that performance thresholds will increase over time as the model matures.

“This is a high-stakes situation,” Sutton acknowledged. “If improvement really drives better outcomes, it’s a no-brainer. If it doesn’t, organizations risk not achieving full payment.”

Although CMS has not released all model details on payments, ACCESS would not immediately change clinicians’ existing Medicare payment obligations or reporting requirements. CMS has framed the initiative as an additional pathway, allowing providers to test outcome-aligned chronic care while continuing to operate within established reimbursement structures.

CMS has also emphasized that aggregated, risk-adjusted performance results will be made public. Over time, the agency expects transparency to reinforce competition based on outcomes and support informed referral decisions.

Stakeholder Response

Early responses from provider organizations, health policy analysts, and digital health trade associations indicate interest in ACCESS as a new approach to funding technology-enabled chronic care. The Alliance for Connected Care praised CMS for introducing an outcome-aligned payment structure that explicitly supports flexible care pathways, arguing that longstanding payment barriers have limited clinicians’ ability to deploy digital tools, even when those tools improve outcomes. The American Telemedicine Association similarly welcomed ACCESS as part of CMS’s efforts to modernize chronic care through technology and to focus on value and outcomes without relying on full rulemaking, which the group said could enable faster innovation.

Physician organizations have also responded favorably. The American Medical Association welcomed ACCESS as a voluntary pathway for integrating technology-supported care into Original Medicare. AMA Chief Executive Officer John Whyte described the model as “an important step toward bringing new, effective digital health tools into everyday care for Medicare patients.”

Policy analysts have highlighted ACCESS’s broader implications. Mark McClellan and Christina Silcox of the Duke-Margolis Institute for Health Policy described the model as a key step toward translating emerging digital and AI capabilities into improved access, quality, and affordability, while laying groundwork that could inform future system-wide adoption.

Primary care groups have emphasized the importance of implementation details. The American Academy of Family Physicians expressed support for ACCESS’s goals while underscoring the need for clarity around methodology and safeguards to preserve continuity of care. “We’re advocating to make sure this model does not disrupt the physician-patient relationship,” said David Tully, the Academy’s vice president of government relations.

The Healthcare Technology Ecosystem

Since its announcement, ACCESS has often been described as a digital health model. CMS officials have been careful to emphasize that technology itself is not what Medicare is paying for. At the December 4 event, Amy Gleason, strategic advisor to HHS and CMS and acting administrator of the Department of Government Efficiency, described ACCESS as a missing payment mechanism for a health technology ecosystem that has matured faster than Medicare’s reimbursement rules.

“The technology is real. The ecosystem is proving this is possible,” Gleason said. “What’s been missing is a payment mechanism that supports technology-enabled care and the providers who use it.”

ACCESS participants may use Food and Drug Administration (FDA)-authorized devices, software subject to enforcement discretion, or other digital tools to support care. CMS is deliberately avoiding technology-specific reimbursement in favor of payments that support the full set of services required to achieve outcomes.

To complement that approach, CMS and FDA also announced the Technology-Enabled Meaningful Patient Outcomes (TEMPO) for Digital Health Devices Pilot, which allows certain digital health technologies used within ACCESS to operate under FDA enforcement discretion while generating real-world evidence. Together, the initiatives reflect a broader effort across the Department of Health and Human Services to align payment, regulatory, and innovation policies.

Widespread Interest with Practical Considerations

The fact that more than 500 organizations had submitted letters of intent by January 30 suggests strong interest in the model. At the same time, clinicians and provider organizations are beginning to assess how ACCESS would operate in practice. Questions have focused on how outcome targets will be calibrated, how patient complexity will be reflected, and how performance will be assessed over time.

Sutton has emphasized that ACCESS is designed to reward directional improvement rather than perfection. “Showing improvement matters,” he said, pointing to measures such as hemoglobin A1c levels, blood pressure, and patient-reported outcomes.

For many providers, participation decisions will ultimately hinge on operational readiness, data-sharing capacity, and confidence in their ability to deliver consistent improvement across defined patient populations. While applications for the first cohort are due in April 2026, applications will be accepted on a rolling basis, and subsequent cohorts for ACCESS will launch January 1, 2027, and quarterly thereafter. This rolling timeline gives potential participants time to evaluate this decision.

Measuring Success

CMS officials have been clear that ACCESS is intended to generate durable evidence about how Medicare can pay for technology-enabled chronic care. Annual evaluations and public reporting will inform whether the approach can be certified and expanded.

For Sutton, success begins with patient outcomes. “When I think about success here, I think about the patients we’re trying to impact, people living healthier lives,” he told the AMA.

Whether ACCESS ultimately becomes a permanent feature of Medicare payment policy will depend on its ability to demonstrate both improved outcomes and sustainable spending growth. Either way, the model marks a notable and potentially important step in CMS’s ongoing effort to modernize how Medicare pays for chronic care.