New voluntary CMS pay model encourages use of health tech
What’s the news: The Centers for medicare & Medicare Services (CMS) has launched a voluntary initiative to test technology-supported care for patients with chronic conditions who are covered by traditional Medicare.
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model aims to overcome Medicare’s barriers to implementing technological advancements that can definitely help patients manage their chronic conditions.
The ACCESS Model focuses on common conditions such as high blood pressure, diabetes, chronic musculoskeletal pain, depression and others that affect millions of Americans and about two-thirds of Medicare beneficiaries.
The ACCESS Model aims to align payments with measurable improvements in patients’ chronic conditions based on each person’s starting point and tailored to patients’ needs for care rather than the individual services provided. By encouraging the use of telehealth,wearable monitoring devices,digital coaching tools and other innovative technologies,the model aims to help modernize chronic disease management and expand access for patients who have traditionally faced barriers to technology-enabled care.
Why it’s critically important: “ACCESS is an important step toward bringing new, effective digital health tools into everyday care for Medicare patients. We applaud CMS and, in particular, Director Abe Sutton’s team at the Center for Medicare and Medicaid Innovation, for this new approach,” AMA CEO John Whyte, MD, MPH, said in a statement.
“for to long, outdated payment barriers have made it challenging for physicians to use new tools that can improve care for common chronic conditions,” Dr. Whyte added. “This new model has the potential to give clinicians more flexibility, strengthen care teams, and-most importantly-help patients live healthier lives. The AMA looks forward to supporting physicians as they adopt technology-enabled care models in ways that enhance the patient-physician relationship.”
The ACCESS Model is testing an idea called outcome-aligned payments for Medicare-enrolled care organizations.
“Participating organizations will receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes,” the ACCESS Model webpage says. “The model focuses on
CMS’s ACCESS Model Offers Flexibility in Value-Based care, Aims for July 2026 Launch
The Centers for Medicare & Medicaid Innovation (CMMI) is launching the ACCESS (Accelerating Care Excellence through System-level Strategies) Model, a new approach to value-based care designed to offer healthcare organizations greater flexibility than previous models.The model focuses on achieving specific clinical outcomes rather than dictating specific treatments or technologies. Applications for the first performance period, beginning July 1, 2026, are due April 1, 2025, with late submissions considered for a January 1, 2027 start.
According to a recent interview with CMMI Director Dr. Michael Sutton featured by the American Medical Association (AMA), the ACCESS Model differs from other value-based care initiatives by allowing providers to “define very specific clinical outcomes that we are going to track” and then “use whatever approaches you need to use.” this contrasts with models that pre-select specific services or technologies for reimbursement. The ACCESS Model allows organizations to bundle approaches and technologies to create care pathways tailored to their patients, focusing on specific conditions without assuming financial risk for the patient’s total cost of care.
“We’re not specifically going through and saying: ‘We’ll pay for this one, or we’ll pay for that one,’ and let you choose to bundle them together and say: This is the care pathway and regimen that I want to use without signing up for global risks on the entire care the patient represents, but on those conditions,” Dr. Sutton explained.
Prior to joining CMMI in January, Dr. Sutton was a principal at Rubicon Founders, where he co-founded health service companies Honest Health, focused on primary care, and Evergreen Nephrology, focused on nephrology.
How to Apply & Learn More:
* ACCESS Model Interest Form: Complete the form at https://app.innovation.cms.gov/ACCESSLOI/ to receive notification when the full application becomes available.
* CMS ACCESS Model Page: Find detailed information and frequently asked questions on the CMS website: https://www.cms.gov/priorities/innovation/innovation-models/access
* AMA Advocacy in Action: Explore the AMA’s advocacy efforts related to Medicare payment reform and other priorities: https://www.ama-assn.org/advocacy
Related Coverage: The AMA also highlights the growth of choice reimbursement approaches in Medicare: https://www.ama-assn.org/practice-management/payment-reimbursement/medicare-growing-alternative-reimbursement-approaches
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