{"id":12919,"date":"2026-04-28T04:53:01","date_gmt":"2026-04-28T04:53:01","guid":{"rendered":"https:\/\/medical-article.com\/?p=12919"},"modified":"2026-04-28T04:53:01","modified_gmt":"2026-04-28T04:53:01","slug":"cmmis-advancing-chronic-care-with-effective-scalable-solutions-access-model-explained","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=12919","title":{"rendered":"CMMI\u2019s Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model Explained"},"content":{"rendered":"

In May 2025, CMS\u2019s Center for Medicare & Medicaid Innovation (CMMI) unveiled it\u2019s \u201cMake America Healthy Again<\/a>\u201d vision. CMMI models focus on not only \u201cprotecting the federal taxpayer,\u201d but also (i) promoting evidence-based prevention, (ii) empowering people to achieve their health goals, and (iii) driving choice and competition for people. CMMI has introduced a number of new alternative payment models to support this vision which include: <\/p>\n

IOTA (Increasing Organ Transplant Access) Model: July 1, 2025 \u2013 June 30, 2031GENEROUS (GENErating cost Reductions for U.S. Medicaid): January 1, 2026 \u2013 December 31, 2030ACCESS (Advancing Chronic Care with Effective Scalable Solutions) Model: July 5, 2026 \u2013 June 30, 2035GLOBE (Global Benchmark for Efficient Drug Pricing): October 1, 2026ASM (Ambulatory Specialty Model): January 1, 2027 \u2013 December 31, 2033TEAM (Transforming Episode Accountability Model): January 1, 2026 \u2013 December 31, 2030AHEAD (Achieving Healthcare Efficiency Through Accountable Care): July 2025 \u2013 December 31, 2035MAHA ELEVATE (Make America Health Again: Enhancing Lifestyle: September 1, 2026LEAD (Long-term Enhanced ACO Design) Model: January 1, 2027 \u2013 December 31, 2036<\/p>\n

A recent AHLA article<\/a> summarizes the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) model. Here is an overview:<\/p>\n

The Centers for Medicare & Medicaid Services (CMS) Innovation Center has launched the ACCESS Model, a groundbreaking 10-year nationwide program running from July 2026 through June 2036 that fundamentally reimagines how Medicare pays for chronic disease management. Rather than traditional fee-for-service billing, ACCESS uses Outcome-Aligned Payments (OAPs) <\/strong>that reward healthcare providers for achieving measurable health improvements in patients with chronic conditions. Participants receive annual payments ranging from $90 to $420 per beneficiary depending on the track (see 4 below) and care period (initial or follow-on), with full payment contingent on meeting clinical outcome targets and minimizing duplicative services. Of note, \u201cParticipants in the Model accept the OAP methodology for achieving outcomes for aligned beneficiaries as a replacement for traditional FFS billing<\/strong> for services rendered to these beneficiaries.\u201d The model initially covers four clinical tracks<\/strong>: <\/p>\n

Early Cardio-kidney-metabolic (eCKM)Hypertension (HTN), or two or more of the following conditions: 1) dyslipidemia, 2) obesity or overweight with marker of central obesity,* or 3) prediabetes. Cardio-kidney-metabolic (CKM)One or more of the following conditions: 1) diabetes mellitus, 2) chronic kidney disease (CKD) stage 3a or 3b, or 3) atherosclerotic cardiovascular disease (ASCVD)Musculoskeletal (MSK)Chronic MSK pain (i.e., lasting >3 months)Behavioral Health (BH)One or more of the following conditions: 1) depression, or 2) anxiety<\/p>\n

The ACCESS Model represents a significant shift toward technology-enabled care delivery<\/strong>, granting participants flexibility to provide services through remote monitoring, virtual consultations, connected medical devices, and FDA-cleared software while maintaining nationally recognized clinical standards. A notable feature is the Technology-Enabled Meaningful Patient Outcomes for Digital Health Devices Pilot (TEMPO Pilot<\/a>) , which allows digital health device manufacturers to obtain FDA enforcement discretion for devices not yet authorized<\/strong>, enabling real-world data collection under controlled conditions. However, participants face important restrictions, including a prohibition on billing Medicare fee-for-service for aligned beneficiaries, which creates revenue challenges particularly for traditional health systems with multiple service lines. To encourage care coordination, the model introduces new co-management payments of approximately $30 that allow primary care physicians to bill for reviewing patient updates and coordinating with ACCESS participants.<\/p>\n

The model presents opportunities for digital health companies, accountable care organizations (ACOs), and technology vendors who can partner with participants or participate directly, though many industry stakeholders have expressed concerns that the payment rates are too low<\/strong> to incentivize widespread adoption given the required infrastructure investments (Modern Healthcare<\/a>). Several commercial payers, including major insurers like UnitedHealthcare, Cigna, and Humana, have already signed pledges to implement similar outcome-aligned payment options<\/strong> (RAC Monitor<\/a>), suggesting this approach may become standard across both Medicare and private insurance. While focusing on outcomes and digital technology is a laudable goal, organizations considering participation must navigate complex legal and operational requirements, including entity formation, Medicare enrollment, HIPAA compliance, FDA regulations for digital devices, and federal fraud and abuse laws.<\/p>\n

The full article with much more detail is available here<\/a> for AHLA members.<\/p>","protected":false},"excerpt":{"rendered":"

In May 2025, CMS\u2019s Center for Medicare & Medicaid Innovation (CMMI) unveiled it\u2019s \u201cMake America Healthy Again\u201d vision. CMMI models focus on not only \u201cprotecting the federal taxpayer,\u201d but also (i) promoting evidence-based prevention, (ii) empowering people to achieve their health goals, and (iii) driving choice and competition for people. CMMI has introduced a number…<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-12919","post","type-post","status-publish","format-standard","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12919"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=12919"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/12919\/revisions"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=12919"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=12919"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=12919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}