ACCESS
Advancing Chronic Care with Effective, Scalable Solutions
The ACCESS 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 specific activities or devices.
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
ACCESS is open to 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
- Not enrolled in Medicare Advantage
Provider Eligibility
Organizations must be Medicare Part B-enrolled providers or suppliers, excluding DME and lab suppliers, and meet specific compliance and oversight requirements.
- Enrolled in Medicare Part B as a provider or supplier
- Not a durable medical equipment (DME) or laboratory supplier
- 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
Care Categories
Early Cardio-Kidney-Metabolic (eCKM)
Cardio-Kidney-Metabolic (CKM)
Musculoskeletal (MSK)
Behavioral Health (BH)
Program Benchmarks & Thresholds
eligibility
financial
operational
quality
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