CMS announces tech-driven alternative payment model

CMS’ Center for Medicare and Medicaid Innovation (CMMI) says its ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, set to begin July 1, 2026, will center on technology-supported care for chronic conditions. The first performance period’s application portal will open in January and close April 1.

David Tully, the Academy’s vice president of government relations, said the AAFP was readying a detailed response to the model.

“The model’s goals for improved health outcomes are aligned with the AAFP’s principles,” Tully said. “We need clarity, though, about its methodology and tools. We also want to ensure that ACCESS patients maintain strong relationships with their usual source of primary care.”

What ACCESS is designed to do and how it would pay participants

CMMI says its new model is meant to test “an outcome-aligned payment approach in original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage chronic disease” such as high blood pressure, diabetes, chronic pain and depression.

Health systems and practices that opt into ACCESS would receive outcome-aligned payments (OAPs) within Medicare Part B reimbursement for chronic-condition management. Further payments would be tied to specified outcome measures across the enrolled population, though CMMI has not yet specified the payment rate.

The model’s starting care tracks are

• early cardio-kidney-metabolic,
• cardio-kidney-metabolic,
• musculoskeletal and
• behavioral health.

ACCESS targets patients and vendors as key participants

Unusually, Medicare beneficiaries also will be able to enroll directly with ACCESS participants or after a clinician referral. CMS says it will maintain a directory of participants, including the conditions they treat and their clinical outcomes.

Also unique to this model, participants are likely to include health technology companies that deliver direct services to patients. Like clinicians, vendors would have to be enrolled as a Medicare Part B provider or supplier. CMS says it will publish a separate directory for these vendors.

The model’s planned benefits for patients who enroll include access to health technology, including wearable health monitoring devices (which may require payment or a paid subscription).

Which technologies and devices will drive the model?

CMS has so far released limited information about ACCESS. The agency says “digital technologies are transforming the way care is delivered, helping people manage chronic conditions with continuous support beyond the doctor’s office” and lists as examples

• telehealth software;
• wearable devices, including those that monitor sleep, heart rate, movement and blood sugar; and
• apps that suggest lifestyle changes.

Such hardware and software would be part of how CMMI says the model would achieve the goal of delivering “integrated, technology-supported care,” and how OAPs would be distributed.

Tully said the Academy will ask CMS for more specific direction on these aspects of the model and a number of others, including

• how primary care physicians and referring clinicians coordinating ACCESS-related care may bill for co-management, without beneficiary cost-sharing;
• whether family physicians whose patients enroll in ACCESS will have to use vendors they haven’t chosen;
• how CMMI will ensure that the interventions and devices offered by vendors are safe, effective and evidence-based;
• how the agency will ensure that ACCESS won’t fragment care; and
• how the agency will promote transparency between ACCESS participants and primary care physicians about the technologies used in the model.

“ACCESS could end up affecting many of our members, many of whom already want to know more about how technology can benefit their practices and patients,” Tully said. “We’re advocating to make sure this model does not disrupt the physician-patient relationship.”