What’s the news: The Centers for Medicare & Medicare Services (CMS) has launched a voluntary initiative to test technology-supported care for patients with chronic conditions who are covered by traditional Medicare.
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model aims to overcome Medicare’s barriers to implementing technological advancements that can help patients manage their chronic conditions.
The ACCESS Model focuses on common conditions such as high blood pressure, diabetes, chronic musculoskeletal pain, depression and others that affect millions of Americans and about two-thirds of Medicare beneficiaries.
The ACCESS Model aims to align payments with measurable improvements in patients’ chronic conditions based on each person’s starting point and tailored to patients’ needs for care rather than the individual services provided. By encouraging the use of telehealth, wearable monitoring devices, digital coaching tools and other innovative technologies, the model aims to help modernize chronic disease management and expand access for patients who have traditionally faced barriers to technology-enabled care.
Why it’s important: “ACCESS is an important step toward bringing new, effective digital health tools into everyday care for Medicare patients. We applaud CMS and, in particular, Director Abe Sutton’s team at the Center for Medicare and Medicaid Innovation, for this new approach,” AMA CEO John Whyte, MD, MPH, said in a statement.
“For too long, outdated payment barriers have made it difficult for physicians to use new tools that can improve care for common chronic conditions,” Dr. Whyte added. “This new model has the potential to give clinicians more flexibility, strengthen care teams, and—most importantly—help patients live healthier lives. The AMA looks forward to supporting physicians as they adopt technology-enabled care models in ways that enhance the patient-physician relationship.”
The ACCESS Model is testing an idea called outcome-aligned payments for Medicare-enrolled care organizations.
“Participating organizations will receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes,” the ACCESS Model webpage says. “The model focuses on clinical improvement or control of a condition based on each person’s starting point, for example, helping a patient with hypertension lower their blood pressure by 10 mmHg.”
CMS will base the payments on the overall share of an organization’s patients that meets the outcome targets, and the agency will also publish risk-adjusted outcomes as a means of “recognizing and rewarding excellent clinical performance.”
In an interview with Dr. Whyte for an episode of the “AMA Moving Medicine” video podcast posted Thursday, Sutton said that “ACCESS is all about advancing chronic care with effective, scalable solutions.”
The model is “about moving beyond a system where we try to define how much should a technology be paid for, or what should we reimburse for a thing, and instead move to a system where we say: Here are the outcomes that matter for a grouping of chronic diseases and focus on the management of those conditions. Let's manage them. Let's drive better outcomes compared to where a patient was. And if you do, you'll be rewarded with a monthly payment that is designed to help fund the activity that you're doing.”
Sutton also outlined what distinguishes the ACCESS Model from earlier attempts to align Medicare payments with patient outcomes.
“We haven't tried it in this way. We've tried outcome-based payments for specific conditions or bundles that are really, really technical. We've had approaches to look at the total cost of care and think about the accountable care organizations,” he said.
The ACCESS Model, by contrast, is an approach that involves “defining very specific clinical outcomes that we are going to track and says: OK, manage that. Use whatever approaches you need to use. Leverage different technologies that are out there. We're not specifically going through and saying: ‘We'll pay for this one, or we'll pay for that one,’ and let you choose to bundle them together and say: This is the care pathway and regimen that I want to use without signing up for global risks on the entire care the patient represents, but on those conditions—not the top, total cost program.”
Before taking on his role with the Centers for Medicare & Medicaid Innovation in January, Sutton was a principal at Rubicon Founders. There, he co-founded two health service companies: Honest Health, which focuses on enabling primary care physicians; and Evergreen Nephrology, which focuses on enabling nephrologists.
Watch Dr. Whyte’s interview with Director Sutton now.
Learn more: To be considered for the ACCESS Model’s first performance period beginning July 1, 2026, applications must be submitted by April 1. Applications received after this date will be considered for a Jan. 1, 2027, start. Complete the ACCESS Model Interest Form to be notified when the application becomes available.
The ACCESS Model page on the CMS website includes further details and answers to frequently asked questions.
Visit AMA Advocacy in Action to find out what’s at stake in reforming Medicare payment and other advocacy priorities the AMA is actively working on.
