Medicare is fundamentally changing how it pays for chronic disease management by rewarding doctors for achieving measurable health improvements rather than counting office visits. The Centers for Medicare and Medicaid Services (CMS) launched the ACCESS model on July 5, 2026, a voluntary 10-year program designed to expand access to technology-supported care for people managing conditions like high blood pressure, diabetes, chronic pain, and depression. The shift addresses a long-standing payment gap: traditional fee-for-service Medicare reimburses specific activities, not outcomes, making it difficult for clinicians to offer innovative digital care options that improve patient health.

What Problem Does ACCESS Actually Solve?

For decades, Original Medicare lacked a payment mechanism that aligned with how modern technology-supported care is delivered. Patients with chronic conditions often need continuous monitoring and coaching beyond scheduled office appointments, yet Medicare's traditional billing structure doesn't compensate providers for remote monitoring, app-based lifestyle coaching, or asynchronous patient education. This created a paradox: the tools existed to help seniors manage their conditions better, but the payment system didn't support their use. ACCESS eliminates this barrier by introducing Outcome-Aligned Payments (OAPs), which provide recurring payments to participating care organizations based on achieving measurable health improvements.

The model focuses on clinical improvement relative to each patient's starting point. For example, a care organization receives full payment when a patient with high blood pressure lowers their reading by 15 millimeters of mercury, or when a person with diabetes achieves better control of their hemoglobin A1c levels. This outcome-focused approach gives clinicians flexibility to deliver care in whatever way works best for each patient, whether through in-person visits, virtual consultations, wearable device monitoring, or smartphone apps.

How Does Technology-Supported Care Work Under ACCESS?

Participating care organizations are expected to offer integrated services that combine clinical oversight with digital tools and lifestyle support. The model recognizes that managing chronic disease requires more than medication; it requires sustained behavioral change and continuous monitoring. Organizations participating in ACCESS can offer a range of services tailored to patient needs:

• Clinical Consultations: Direct interaction with physicians and clinicians, delivered in-person or virtually as clinically appropriate
• Lifestyle and Behavioral Support: Coaching on nutrition, exercise, smoking cessation, and other behavioral modifications that improve health outcomes
• Therapy and Counseling: Mental health services and behavioral health support integrated with physical health management
• Patient Education and Care Coordination: Ongoing education about disease management and coordination between the ACCESS organization and the patient's primary care provider
• Medication Management: Optimization and monitoring of medications with regular adjustments based on patient response
• Diagnostic Testing and Monitoring: Ordering and interpreting diagnostic tests, imaging, and FDA-authorized wearable devices or software that track health metrics continuously

Care delivery can occur through multiple channels, including in-person appointments, telehealth software, asynchronous digital communication, and wearable devices that continuously monitor sleep, heart rate, movement, and blood sugar. This flexibility is especially valuable for seniors in rural areas or communities with limited local care options, where travel to appointments may be difficult or impossible.

Which Chronic Conditions Does ACCESS Cover?

The program launched with four clinical tracks addressing conditions that affect more than two-thirds of people with Medicare. Each track groups related conditions commonly treated with similar types of care, enabling integrated, patient-centered management. The initial tracks include early cardio-kidney-metabolic conditions such as high blood pressure, high cholesterol, obesity, and prediabetes; established cardio-kidney-metabolic conditions including diabetes, chronic kidney disease, and heart disease; chronic musculoskeletal pain; and behavioral health conditions including depression and anxiety.

Expansion is already planned. Starting April 1, 2027, ACCESS will add new tracks for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorder, and tobacco cessation. Importantly, current participants and applicants will not need to reapply to participate in the new tracks; they can simply enroll in additional disease areas. CMS has indicated it may consider additional tracks and conditions in the future based on evidence and clinical need.

How Are Participating Organizations Held Accountable?

Safety and quality are built into the ACCESS model through multiple oversight mechanisms. All participating organizations must enroll as Medicare Part B providers or suppliers, comply with state licensure requirements, and meet Health Insurance Portability and Accountability Act (HIPAA) and FDA requirements. Each organization must designate a physician Clinical Director responsible for clinical oversight and compliance with program standards. CMS will monitor clinical performance continuously and publicly report aggregated, risk-adjusted health outcomes so patients and referring clinicians can make informed choices about which organizations to trust with their care.

The model also strengthens collaboration between ACCESS organizations and traditional primary care. Primary care providers and referring clinicians can refer patients to ACCESS organizations and receive regular electronic updates on patient progress. They can also bill a new co-management payment for documented review of patient updates and associated coordination activities, such as medication adjustments or problem list updates. This creates financial incentives for primary care providers to actively collaborate with ACCESS organizations rather than viewing them as competitors.

What Support Exists for Participation?

CMS has designed multiple pathways to help organizations understand and join the program. Interested care organizations can review a Request for Applications and apply through the Participant Portal. The 10-year model offers rolling start dates, meaning organizations can begin participation at different times rather than all starting simultaneously. This flexibility allows organizations to prepare adequately before launching their programs. Leading medical societies have expressed support for CMS' efforts, and major health plans have pledged to offer an ACCESS-aligned payment option for technology-supported chronic care, signaling broad industry backing for the model.

For patients already enrolled in Original Medicare, information is available at Medicare.gov/ACCESS. Primary care providers and referring clinicians can visit a dedicated webpage to learn how to refer patients and participate in the co-management payment structure. Organizations interested in the new tracks launching in April 2027 can complete an ACCESS Model Interest Form to receive updates without needing to reapply if they are already participating.

Why Does This Matter for Healthcare Innovation?

The ACCESS model represents a significant shift in how Medicare approaches payment reform. Rather than waiting for perfect clinical evidence or requiring technology to prove itself in controlled research settings, CMS is creating a real-world testing ground where innovative care delivery models can be evaluated based on actual patient outcomes. By tying payment to health improvement rather than service volume, the model removes a major barrier that has prevented technology-supported care from scaling. Organizations no longer need to choose between financial sustainability and offering modern, digital-first care; the payment system now rewards both equally.

This approach also addresses a gap identified in recent healthcare technology discussions: many AI and digital health tools remain stuck in research settings because the payment infrastructure doesn't support their clinical use. ACCESS creates a pathway for technology-supported care to move from pilot projects into mainstream practice, provided it demonstrates measurable improvements in patient health. For seniors managing multiple chronic conditions, this could mean more personalized, continuous support and fewer preventable hospitalizations.