What Healthcare Leaders Need to Know About the CMS ACCESS Model

Healthcare leaders have seen no shortage of CMS Innovation Center models over the past decade. Some have focused on new payment structures, while others have emphasized improving quality or reducing costs. Each has offered a glimpse into where healthcare is headed.

The new Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model feels particularly significant, not simply because it introduces another payment model, but because it reflects a broader change in how CMS believes chronic disease should be managed. The CMS ACCESS Model is a voluntary, 10-year CMS Innovation Center model that tests an outcome-aligned payment approach for technology-supported chronic care.¹

At its core, ACCESS recognizes something many healthcare organizations have understood for years: helping patients manage chronic conditions requires more than periodic office visits. It requires ongoing support, better coordination, and technology that extends care beyond the walls of the clinic.

For healthcare leaders, that’s the real story.

ACCESS Signals a Shift in Chronic Care

For years, value-based care has encouraged providers to think differently about chronic disease management. The conversation has gradually moved beyond reducing hospital readmissions or improving quality metrics. Today, the focus is increasingly on helping patients stay healthier over time.

The ACCESS Model builds on that evolution.

Rather than emphasizing the volume of services delivered, the CMS ACCESS Model tests an outcome-aligned payment approach that supports technology-enabled care for some of the most common chronic conditions affecting Medicare beneficiaries, including hypertension, diabetes, chronic musculoskeletal pain, depression, anxiety, and cardio-kidney-metabolic disease.²

That distinction matters because CMS is testing more than just another payment model. It’s evaluating whether giving patients greater access to technology-supported care can improve health outcomes while creating better value for Medicare.¹

Why the CMS ACCESS Model Matters

Managing chronic disease has never been limited to what happens during an office visit.

Patients make decisions every day that affect their health. They remember or forget medications. They check their blood pressure. They struggle with pain, depression, diet, transportation, or simply understanding what comes next.

Those moments rarely happen when a physician is in the room, and that’s one of the biggest challenges in chronic disease management today. Clinical teams often don’t know a patient is struggling until the next appointment, an emergency department visit, or a hospitalization.

ACCESS acknowledges that reality by supporting services like remote monitoring, medication management, lifestyle coaching, behavioral health support, and ongoing patient engagement because those interventions help address problems before they become crises.¹

It’s a subtle shift, but an important one. Instead of asking, “What happened during the visit?” ACCESS asks, “How do we help patients stay healthier between visits?”

Technology Alone Isn’t the Answer

One of the biggest misconceptions about digital health is that technology alone improves outcomes.

It doesn’t.

Technology gives care teams better tools to identify patients who need support, prioritize outreach, monitor progress, and communicate more effectively. The real value comes from how clinicians, care coordinators, and patients use those insights to improve care.

ACCESS reflects this philosophy. The model isn’t designed to replace physicians or primary care. Instead, it creates opportunities for technology-supported care organizations to work alongside existing care teams by providing structured care updates, supporting patients outside traditional appointments, and helping coordinate care over time.³

That’s an important distinction. The future of chronic disease management isn’t about replacing clinical relationships. It’s about strengthening them.

A Different Way to Think About Value-Based Care

One of the more interesting aspects of ACCESS is what it says about the future of reimbursement.

Historically, healthcare has largely paid for activities. Office visits, procedures, tests, and treatments each have an associated payment.

ACCESS takes a different approach by testing whether organizations should instead be rewarded for helping patients improve their health.

That’s a meaningful shift.

It places greater emphasis on prevention, patient engagement, measurable outcomes, and long-term disease management rather than simply documenting services provided.

Whether ACCESS ultimately expands or influences future payment models, it reflects the direction CMS is moving.

Questions Healthcare Leaders Should Be Asking

Healthcare organizations don’t have to participate in ACCESS to learn from it.

The model raises several important questions that apply well beyond Medicare demonstrations.

• Are we engaging patients consistently between office visits? 

• Can we identify when a patient’s condition is beginning to worsen? 

• Do we understand the barriers preventing patients from following their care plans? 

• Are we using technology to make care teams more effective, or simply adding more technology? 

• Can our care model scale as value-based reimbursement continues to evolve  

Those questions are becoming increasingly relevant across virtually every area of chronic disease management.

How CareHarmony Supports This Vision

Many of the capabilities highlighted within the ACCESS Model have long been central to CareHarmony’s approach to chronic care management.

Through AI-enabled CareBlocks®, evidence-based clinical pathways, technology-enabled care coordination, and longitudinal patient engagement, CareHarmony helps healthcare organizations extend care beyond the traditional office visit.

Care coordinators maintain regular communication with patients, identify barriers that may affect adherence, encourage healthy behaviors, facilitate communication across providers, and help patients navigate the day-to-day challenges of managing chronic disease.

These ongoing interactions complement the work of primary care physicians and specialists by helping patients stay engaged with their care plans while giving providers greater visibility into what is happening between visits.

None of these capabilities are entirely new. What’s changing is that CMS is expanding its support for these capabilities by testing new payment approaches that further align reimbursement with long-term outcomes.

Looking Ahead

Whether ACCESS becomes a permanent Medicare model or helps shape future payment policy, one message is already becoming clear: healthcare organizations that invest in scalable care coordination, meaningful patient engagement, and technology that strengthens clinical relationships will be better positioned for the future of value-based care.

Ultimately, the CMS ACCESS Model isn’t just testing a new payment approach. It’s signaling where chronic disease management is headed.

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Frequently Asked Questions About the CMS ACCESS Model

What is the CMS ACCESS Model?

The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a voluntary 10-year CMS Innovation Center model that tests an outcome-aligned payment approach for technology-supported chronic care. The model is designed to expand access to innovative services that help people prevent and manage chronic disease while improving health outcomes.¹

Who is eligible for ACCESS?

The model focuses on chronic conditions affecting more than two-thirds of Medicare beneficiaries, including hypertension, diabetes, chronic musculoskeletal pain, depression, anxiety, and cardio-kidney-metabolic conditions. Individuals with Original Medicare who meet the qualifying criteria may be eligible to participate through participating ACCESS organizations.²

How is the CMS ACCESS Model different from traditional Medicare?

Unlike traditional fee-for-service reimbursement, the CMS ACCESS Model tests an outcome-aligned payment approach that places greater emphasis on patient outcomes rather than the volume of services delivered. Participating organizations are encouraged to use technology-supported care, remote monitoring, coaching, medication management, and ongoing patient engagement to help patients improve their health.¹

What does the CMS ACCESS Model mean for healthcare organizations?

The CMS ACCESS Model reflects CMS’s continued movement toward value-based care by encouraging healthcare organizations to strengthen care coordination, leverage technology responsibly, and support patients beyond traditional clinical encounters. Even organizations that do not participate directly can view the model as an indicator of where chronic disease management is heading.

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References

1. Centers for Medicare & Medicaid Services. ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model.
2. Centers for Medicare & Medicaid Services. ACCESS Technical Frequently Asked Questions.
3. Centers for Medicare & Medicaid Services. Improving ACCESS to Technology-Supported Care with Outcome-Aligned Payments.