The Center for Medicare & Medicaid Innovation (CMMI) has announced a new program, the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions), to pay for technology-based services to help with chronic condition management. The ACCESS Model Website has more details on the program.
Under ACCESS, Medicare will pay for chronic condition technologies and tools such as AI analytics, prescription digital therapeutics, remote patient monitoring, and personalized coaching. This new program is voluntary and is expected to run for 10 years starting July 1, 2026. Applications for the first performance period are due March 20, 2026.
What is new about this model?
ACCESS provides reimbursement for the technology and tools to help manage chronic conditions. It acknowledges the fact that chronic condition management results in 90% of the cost of care nationwide. It allocates resources behind improving care for some of these conditions, which should reduce overall costs in the long run.
Outcome-Aligned Payments. Instead of just paying for the number of visits or services, this model rewards organizations for achieving tangible health improvements in patients, for example blood pressure and cholesterol management, better diabetes control, better control of chronic musculoskeletal pain, and better management of behavioral health conditions. These include improved quality of life metrics as measured by patient-reported outcomes. By focusing on these outcomes, the measurement of which is enabled by the technology, the program is hoped to be much more effective than fee-for-service reimbursement models.
Notably, the data to support reimbursement is combined with the capabilities of the devices that CMS is reimbursing to produce the outcomes data. Data will also be sourced from health information exchanges. This is an intriguing approach that CMS has deemed to be worth trying out.
For HealthTech leaders, this is an encouraging development. It sets up an actual program for outcomes-based reimbursement for emerging technology that, if it works, might be expanded.
In addition, the model is very inclusive, allowing a wide range of organizations, from established digital chronic care platforms to specialty practices, to participate. Medicare beneficiaries can enroll directly, giving them more agency in choosing their care.
While enthusiasm should be high for this program, there are also some practical considerations. Implementing an outcomes-based model requires significant investment, including for example a robust technology infrastructure, seamless data integration, and skilled staff to manage the new workflows. This could prove especially challenging for smaller organizations or those in rural areas.
Data management is also critical. To show the outcomes, participants will need to collect and share reliable clinical data, not just claims data, which means tighter integration with electronic health records and health information exchanges.
The ACCESS Model is worth watching as it rolls out. It is bold, but also follows precedent in reimbursement for new technology, value-based care payment, and the widely accepted idea of focusing cost cutting efforts on the most expensive care, in this case chronic condition management.
