CMS ACCESS Model – CMS has spent more than a decade trying to move Medicare toward a system that pays for outcomes rather than activity. The goal, stated explicitly by the CMS Innovation Center, is to have 100 percent of Original Medicare beneficiaries in accountable care relationships by 2030. Since 2010, the Innovation Center has launched over 50 models working toward that target. ACOs grew. Care management programs expanded. Digital health tools found their way into clinical workflows.
And still, for the two-thirds of Medicare beneficiaries living with at least one chronic condition, outcomes remained stubbornly flat relative to the investment.
The missing piece wasn’t technology or clinical intent. It was the payment model. Most value-based care programs, including Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Advanced Primary Care Management (APCM), still paid providers for doing things, not for whether those things made patients healthier. The underlying logic of fee-for-service never fully went away. It just wore different clothes.
What is the CMS ACCESS Model?
Announced by the CMS Innovation Center in December 2025, the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year voluntary payment program launching July 1, 2026. It introduces a new payment structure called Outcome-Aligned Payments (OAPs), where participating organizations receive recurring payments for managing patients’ chronic conditions, with full payment tied to whether those patients meet CMS-defined clinical improvement thresholds.
The model targets conditions organized into four clinical tracks:
• Early Cardio-Kidney-Metabolic (eCKM): Hypertension, dyslipidemia, prediabetes, and obesity
• Cardio-Kidney-Metabolic (CKM): Diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease
• Musculoskeletal (MSK): Chronic musculoskeletal pain
• Behavioral Health (BH): Depression and anxiety
Applications opened January 12, 2026. Organizations aiming for the first cohort must apply by April 1, 2026. CMS will continue accepting rolling applications through 2033.
The Patients Nobody Had a Model For
Most value-based care programs were designed around a familiar logic. Finding the highest-cost patients, reducing their utilization, and capturing the savings. That math works when the target population is small, complex, and expensive enough to justify $100 to $150 per member per month in care management spend. It doesn’t work for everyone else.
Most Medicare fee-for-service beneficiaries don’t fall into that high-cost tier. They carry chronic conditions like prediabetes, hypertension, or mild depression, conditions that are manageable but go largely unaddressed because no financial model made it worth engaging them at scale. Too low cost for intensive care management, too high-need to ignore. The industry simply didn’t have a viable answer for this population.
ACCESS was built precisely for this gap. The OAP structure makes the economics of lighter-touch, technology-enabled engagement viable for a much larger and previously underserved population. Where other VBC programs required heavy human intervention to justify the investment, ACCESS aligns with a delivery model built around continuous, AI-supported engagement at scale. That’s not a workaround. That’s the design intent.
This is why some of the criticism around ACCESS reimbursement rates misses the point. It works when the delivery model matches the population: scalable, technology-driven, and built to engage many rather than intensively serve few.
Why ACCESS Changes the Incentive Structure
Programs like CCM, RPM, and APCM accomplished something important. They normalized technology-supported, continuous care within Medicare reimbursement and helped organizations build real clinical infrastructure. But the payment logic stayed the same. Payment was still tied to documented activity, care manager contact, device data transmission, time spent. These are process measures. They do not tell CMS, or anyone else, whether the patient’s health improved.
ACCESS removes that logic entirely. Care can be delivered in person, virtually, or asynchronously. The clinical tools and workflows can look like existing CCM or RPM programs. But the financial outcome hinges on one question: did the patient’s health improve against a defined baseline? That shift changes the incentive structure and raises the bar for what care infrastructure needs to deliver.
How to Prepare for ACCESS Model?
ACCESS is straightforward in concept but demanding in practice. Organizations looking to participate need infrastructure that can deliver on outcomes at scale, not just manage care activities.
- Population visibility
Identifying which patients qualify across which tracks before July 2026 is essential. That requires a platform capable of surfacing eligible patients by condition, risk level, and care gap status without manual chart reviews. - Continuous data capture
ACCESS requires outcome measurement against a defined clinical baseline. Tracking markers like blood pressure, HbA1c, eGFR, and UACR over time, across a large patient population, is not something that can be done with episodic data collection. - Interoperability
Participants must report outcomes through FHIR-based APIs and share electronic care updates with referring providers. This is a hard technical requirement under the model. - Coordinated care workflows
ACCESS is built around continuous, team-based engagement. Organizations where care managers, clinical directors, and referring providers work from the same patient data have a structural advantage going in.
Organizations that invested in value-based care infrastructure over the past several years have a head start, but only if their platforms connect the dots between patient data, care workflows, and measurable outcomes.
How Persivia CareSpace® Supports Organizations participating in the CMS ACCESS Model
Persivia’s CareSpace® platform is built specifically for value-based care models like CMS ACCESS Model. Risk stratification and population identification surface eligible patients across all four clinical tracks, prioritized by risk level and care gap severity before the first performance period opens.
AI-driven analytics flag patients trending away from outcome targets while there is still time to intervene.
Patient engagement is where CareSpace®’s agentic AI capabilities become particularly relevant to CMS ACCESS. Agentic AI tools conduct natural-language SMS and voice outreach for follow-ups, appointment reminders, medication adherence, and chronic care education, keeping patients engaged between clinical touchpoints without requiring additional staff capacity.
Patients interact through digital portals, mobile apps, and secure messaging, supporting the kind of continuous self-management ACCESS Model rewards. Social determinant flags enable targeted outreach for at-risk groups, ensuring the populations most likely to miss outcome thresholds are prioritized before a performance period closes.
The Bigger Signal CMS ACCESS Model Sends
CMS ACCESS is one piece of a broader CMS direction. ACCESS Model and the newly announced Long-Term Enhanced ACO Design (LEAD) Model, the successor to ACO REACH launching January 2027, together signal the same thing: CMS is done paying for effort. Read the full breakdown of the LEAD Model here.
For organizations still evaluating whether to engage with ACCESS, the application deadline for the first cohort is April 1, 2026. The infrastructure decisions made between now and then will determine whether an organization is positioned to participate from day one or spending the next cycle catching up.
There is also a longer-term dimension worth paying attention to. The ACCESS Model population, lower-acuity patients with manageable chronic conditions, is precisely the population where AI-driven engagement has the most room to operate. As AI agent technology matures, the model’s design accommodates a future where semi-autonomous, clinician-supervised agents handle outreach, behavioral nudges, medication adherence support, and care navigation for a large patient panel at a fraction of current delivery costs. CMS building CMS ACCESS Model with that direction in mind, whether intentionally or not, puts the model ahead of where most of the industry is thinking. The organizations that recognize this early will have a significant advantage as that technology becomes mainstream.
Frequently Asked Questions
What is the CMS ACCESS Model?
The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model is a 10-year voluntary CMS program launching July 1, 2026. It pays Medicare Part B providers through Outcome-Aligned Payments for managing chronic conditions, with full payment tied to measurable patient health improvements rather than specific services or documented time.
Who is eligible to participate in the ACCESS Model?
Medicare Part B-enrolled providers and suppliers are eligible, excluding durable medical equipment, prosthetics, orthotics, and laboratory suppliers. Participating organizations must designate a physician Clinical Director to oversee quality and compliance.
How is CMS ACCESS Model different from RPM or CCM?
RPM and CCM pay for specific activities, documented minutes, and service codes. ACCESS pays for clinical outcomes. Organizations can use similar tools and workflows, but reimbursement depends on whether patients meet defined improvement thresholds, not whether a set of billable tasks was completed.
When is the ACCESS Model application deadline?
The initial application deadline for the first cohort (launching July 1, 2026) is April 1, 2026. CMS accepts rolling applications through 2033 for organizations targeting later cohort start dates.
What chronic conditions does ACCESS cover?
ACCESS launches with four tracks covering early cardio-kidney-metabolic conditions, established cardio-kidney-metabolic diseases, chronic musculoskeletal pain, and behavioral health conditions including depression and anxiety.
How does ACCESS connect to CMS’s broader value-based care strategy?
CMS has a stated goal of placing 100 percent of Original Medicare beneficiaries in accountable care relationships by 2030. ACCESS is one of the more direct steps toward that goal, specifically addressing the payment gap that has kept chronic care management tied to activity rather than outcomes.
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