CMS will add four condition tracks to its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model starting April 1, 2027, the agency said in a Sept. 15 news release.
Six things to know:
1. The expansion adds heart failure, chronic obstructive pulmonary disease, substance use disorders and tobacco cessation to the model. CMS will also expand support for chronic musculoskeletal pain, extending coverage for certain conditions beyond the model’s initial 12-month care period.
2. The model already covers hypertension, diabetes, chronic musculoskeletal pain and depression. CMS says 3 out of 4 Medicare beneficiaries qualify for at least one track.
3. The ACCESS model ties Medicare payments to measurable improvements in patient health rather than paying solely for individual services. Participating organizations can offer virtual care, health coaching, remote monitoring, and connected devices and wearables between regular doctor visits.
4. There are currently 160 organizations participating in the ACCESS model, and CMS said Medicare will continue to add to the list throughout the model’s 10-year run. The model supports those with traditional Medicare. Medicare Advantage enrollees are not eligible, but CMS said MA plans may offer similar programs.
5. “We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments,” CMS Administrator Mehmet Oz said in the release. “ACCESS is one of the tools we are using to bring healthcare into the digital age, giving patients and their providers greater access to AI-enabled technologies, remote monitoring, connected devices, and other innovative tools that can help identify problems earlier and improve care. This latest expansion of the program will help more Americans get the care they need and reward providers who deliver actual results.”
6. CMS said 17 major health plans covering more than 165 million Americans have pledged to adopt an outcomes-based payment structure aligned with ACCESS. Among them is Blue Shield of California. The payer’s chief medical officer, Ravi Kavasery, MD, said at a Sept. 15 CMS launch event that the model gave the industry clarity on the roles of government, payers, providers and technology vendors, and that Blue Shield is actively developing ACCESS-aligned programs in behavioral health, using the same outcome measures built into the model’s tracks.
