{"id":10661,"date":"2026-03-02T15:22:21","date_gmt":"2026-03-02T20:22:21","guid":{"rendered":"https:\/\/www.appliedpolicy.com\/staging\/7403\/?p=10661"},"modified":"2026-03-02T15:22:21","modified_gmt":"2026-03-02T20:22:21","slug":"how-cms-is-evolving-its-coverage-evidence-strategy-access-vs-maha-elevate","status":"publish","type":"post","link":"https:\/\/www.appliedpolicy.com\/staging\/7403\/how-cms-is-evolving-its-coverage-evidence-strategy-access-vs-maha-elevate\/","title":{"rendered":"How CMS is Evolving its Coverage Evidence Strategy: ACCESS vs MAHA ELEVATE"},"content":{"rendered":"

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<\/a> 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.<\/p>\n

The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model<\/a> will test Outcome Aligned Payments (OAPs) to determine whether technology-enabled chronic care reduces Medicare expenditures while preserving or enhancing quality.\u200b<\/p>\n

As Annie Tuttle has previously written,<\/a> the voluntary ACCESS model focuses on chronic conditions\u2014including hypertension, diabetes, chronic musculoskeletal pain, and depression\u2014and 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.<\/p>\n

The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model<\/a> 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.<\/p>\n

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\u2019s evolving CMS coverage evidence strategy.<\/p>\n

Treatment of Chronic Diseases<\/h3>\n

ACCESS and MAHA ELEVATE both aim to address chronic disease but emphasize different aspects of care.<\/p>\n

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:<\/p>\n