ACCESS
Advancing Chronic Care with Effective, Scalable Solutions
The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model is a 10-year national test of a new payment approach designed to expand access to technology-supported care for people with chronic conditions. It provides participating organizations with predictable, recurring payments for helping patients manage qualifying chronic conditions, with full payment depending on achieving measurable health outcomes.
Innovation
ACCESS introduces Outcome-Aligned Payments (OAPs), a recurring payment for managing a patient’s qualifying condition, with payment tied to achieving measurable health outcomes rather than paying for a specific set of services.
The Problem
Today, people with Original Medicare have limited access to technology-supported care services for managing their chronic conditions because of Medicare payment barriers.
The Solution
Through ACCESS, CMS will test a new payment option that emphasizes outcomes over activities, enabling clinicians to offer innovative technology-supported care that improves patients’ health and complements traditional care.
Expected Outcomes
Patients will have more options to help them meet their health goals, providers will gain new partners to help them co-manage their patients’ health, and Original Medicare will have a way to pay care organizations developing technology-supported services.
Strategy
ACCESS supports disease prevention and health promotion by empowering people who have Medicare and clinicians with more choices.
Model Goals
- Improve health outcomes
- Enhance patient choice
- Reduce overall Medicare costs
Patient Eligibility
People with Original Medicare who have qualifying chronic conditions included in one of the model’s clinical tracks.
- Enrolled in Original Medicare
- Have a qualifying chronic condition in one of the clinical tracks (eCKM, CKM, MSK, BH)
- Not enrolled in Medicare Advantage
Provider Eligibility
Organizations must be enrolled in Medicare Part B as providers or suppliers, designate a physician Clinical Director, and comply with applicable federal and state requirements.
- Enrolled in Medicare Part B as a provider or supplier (excluding durable medical equipment and laboratory suppliers)
- Have an active Taxpayer Identification Number (TIN)
- Comply with applicable state licensure, HIPAA, and FDA requirements
- Designate a physician Clinical Director responsible for clinical and compliance oversight
- Accept Medicare assignment and the Medicare-allowed amount as payment in full
Care Categories
Early Cardio-Kidney-Metabolic (eCKM)
Cardio-Kidney-Metabolic (CKM)
Musculoskeletal (MSK)
Behavioral Health (BH)
CMS Benchmarks & Thresholds
eligibility
financial
operational
quality
Operational Friction Summary
Where operational friction is highest for this model.
Safety-net providers must identify eligible Medicare patients across four distinct chronic care categories (eCKM, CKM, MSK, BH) and successfully onboard them onto technology platforms to trigger the model's recurring payments.
Full payment in ACCESS depends on achieving measurable health outcomes (e.g., BP control, A1c reduction, PHQ-9 improvement), requiring continuous ingestion of patient-generated health data from various tech platforms.
The model shifts payment from activities to outcomes, meaning providers must achieve specific clinical targets within defined performance periods to secure full payment.
Safety-net systems must partner with third-party technology vendors (digital therapeutics, RPM companies) whose business models must align with the ACCESS model's outcome-based payment structure.
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