Improving ACCESS to Technology-Supported Care with Outcome-Aligned Payments

Improving ACCESS to Technology-Supported Care with Outcome-Aligned Payments

By: Abe Sutton, Director, Center for Medicare and Medicaid Innovation, and
Jacob Shiff, Chief AI & Technology Officer, Center for Medicare and Medicaid Innovation

Technology has transformed daily life, but health care for many people with Medicare has not kept up. Millions live with chronic conditions, such as high blood pressure, diabetes, pain, and depression, which require ongoing, coordinated support. Digital tools like apps, connected devices, and telehealth can extend care and help people live healthier lives, but people with Original Medicare and clinicians have had limited access.

The Centers for Medicare & Medicaid Services (CMS) has begun laying the early infrastructure needed to modernize the nation's digital health ecosystem. This summer, CMS launched the voluntary Health Tech Ecosystem at the White House to improve interoperability, expand patient-directed data mobility, and increase the availability of personalized digital tools. The initiative has grown to more than 450 participants, all preparing for initial ecosystem releases planned for March 2026.

But one critical element has been missing: payment has not kept pace with technology-enabled care, limiting access for beneficiaries and clinicians. The new ACCESS Model is the next step.

Introducing the ACCESS Model

ACCESS-Advancing Chronic Care with Effective, Scalable Solutions-is a new CMS Innovation Center model to expand options for people with Original Medicare and clinicians to manage chronic conditions with technology-supported care. The voluntary 10-year model begins July 2026.

ACCESS will test Outcome-Aligned Payments, a new payment option that rewards health outcomes rather than required activities. Participating organizations receive predictable payments for managing qualifying conditions and earn the full amount only when patients meet measurable health goals, such as lower blood pressure or reduced pain. Care can be in person, virtually, or asynchronous, whatever meets patients' needs.

The model offers an alternative to traditional activity-based payments, which can limit innovation and increase costs. By emphasizing outcomes, ACCESS gives clinicians greater flexibility to adopt technologies that measurably improve health.

How It Works

ACCESS focuses on conditions that affect more than two-thirds of people with Medicare, organized into four clinical tracks:

• Early cardio-kidney-metabolic: hypertension, dyslipidemia, obesity, prediabetes
• Cardio-kidney-metabolic: diabetes, chronic kidney disease, atherosclerotic cardiovascular disease
• Musculoskeletal: chronic musculoskeletal pain
• Behavioral health: depression, anxiety

Participating organizations must manage all conditions within a track, supporting patient-centered care. Services may include clinician consultations, lifestyle and behavioral support, medication management, care coordination, and use of Food & Drug Administration (FDA)-cleared hardware and software devices, among other services.

ACCESS complements patients' care teams. Primary care and other clinicians can refer patients to ACCESS organizations and receive ongoing updates. They may also bill a new co-management payment for reviewing updates and coordinating care.

People with Original Medicare can enroll directly with participating organizations. To help with finding and comparing options, CMS will maintain a directory of participating organizations and their risk-adjusted outcomes. Enrollees keep all Medicare rights and benefits, including access to any Medicare health care provider.

Participating organizations must be enrolled in Medicare Part B and meet federal and state requirements for licensure, compliance, and clinical oversight. Participants report patient progress using validated clinical and patient-reported measures specific to each condition. This approach supports accountability and reinforces safeguards, including Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security and FDA requirements.

A Step Towards Modernizing Medicare

ACCESS is a major step forward in aligning payers, providers, and patients around what matters most: better health at an affordable cost. Fixed, outcome-aligned payments reward cost-effective health improvement and channel innovation toward value rather than volume. Transparent, risk-adjusted outcomes empower people to choose high-performing organizations, enabling effective approaches to scale.

Prevention is central to ACCESS. Payments are tied to control or improvement of leading health indicators, like blood pressure, weight, HbA1c, and cholesterol, so organizations succeed by keeping people healthy.

ACCESS is designed to nurture a robust ecosystem of technology-enabled care organizations and the tools that power them-including artificial intelligence diagnostics that identify people with conditions that might benefit from ACCESS services, devices that monitor biomarkers, and software that streamlines key workflows. Because the model uses standard billing infrastructure, it can potentially scale to other payers, including Medicare Advantage, Medicaid, and commercial plans.

By testing a new outcome-aligned payment option, ACCESS aims to accelerate modernization of American health care and make innovation a driver of better health for millions of people.

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