CMS has been trying to scale value-based care for decades with mixed results — but the agency’s newly announced ACCESS model could represent a more meaningful step toward aligning payment with outcomes and costs.
Over the past 20 years, CMS’ steady progression of payment and care delivery reforms include pay-for-performance, bundled payments, accountable care organizations and alternative payment models. While many of those efforts layered incentives on top of providers’ fee-for-service models, ACCESS is a more explicit attempt to rewire traditional Medicare itself around patient outcomes, total cost of care and flexibility in how care is delivered.
ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. It will allow providers to use digital tools, nontraditional services and care teams that are not typically reimbursed under fee-for-service. Participating providers will take on responsibility for quality and the total cost of care, with the opportunity to share in savings if they improve outcomes and decrease spending.
The model, which is slated to begin on July 1, is designed to promote prevention, continuous engagement and technology-enabled care rather than episodic visits.
Experts think it is CMS’ clearest attempt yet to move traditional Medicare fee-for-service toward an outcomes model, as well as a key effort to help expand care beyond the four walls of a hospital or clinic. However, they provide a caveat: the success of ACCESS will depend on sustained participation, clear metrics and the ability to integrate data and digital tools across fragmented care settings.
How does the model work?
CMS said its ACCESS program will initially focus on conditions affecting more than two-thirds of people on Medicare, including depression, diabetes, high blood pressure and chronic musculoskeletal pain.
Under the program, CMS will evaluate participating providers based on whether their patients’ conditions meaningfully improve over time and whether those improvements translate into lower use of costly services. That includes tracking changes in clinical metrics tied to each condition, as well as downstream effects like fewer hospitalizations, fewer emergency department visits and lower overall Medicare spending for patients seeing an ACCESS-enrolled provider.
Providers that meet or exceed these quality and cost benchmarks can earn shared savings, but those that fall short could face reduced payments.
Rather than paying solely for individual visits or procedures, CMS ties reimbursement to performance on these outcomes — incentivizing care that is more preventive and coordinated.
The model also encourages the use of technology like remote monitoring, digital behavioral health programs and virtual care management teams. All of these are known to help improve patient outcomes but are not typically reimbursed under fee-for-service.
For this reason, companies providing tech-enabled care are bullish on ACCESS. One leader — Ankoor Shah, vice president of clinical excellence at virtual care provider Included Health — said the model is the first serious move within traditional Medicare fee-for-service toward flexibility, outcome-based payment and coverage for services that historically weren’t paid for.
He pointed out that ACCESS is different from prior CMS initiatives meant to promote value-based care. One reason is that it is focuses on Medicare Part B fee-for-service rather than capitation.
Part B has historically operated under a fee-for-service model that reimburses providers for each outpatient visit, with little consideration for long-term patient outcomes. Unlike capitation models, which give providers a fixed budget per patient, ACCESS keeps Part B’s fee-for-service structure but ties payments to measurable outcomes. This means providers are still reimbursed for each service, but they can earn additional shared savings — or incur penalties — based on how well patients’ conditions are managed over time.
This approach allows providers to use technology and care coordination services in ways that have never been financially supported under traditional Part B, Shah declared.
Connected devices can help save money
Shah also highlighted the new model’s emphasis on what happens outside clinical settings, as ACCESS recognizes that wearables, digital programs, specialty care models and ongoing patient engagement all play an important role in outcomes.
For example, this new coverage could allow a Medicare patient with heart failure to receive a combination of remote monitoring and in-person care rather than relying solely on office visits.
A provider participating in ACCESS might use connected devices — such as smart scales and blood pressure monitors to track weight and blood pressure at home — paired with nurse-led check-ins, during which clinical staff can make medication adjustments and referrals to nutrition or cardiac rehab programs.
These types of interventions help prevent chronic conditions from worsening to the point of hospitalization, Shah remarked.
CMS’ goal is to generate savings from the eventual reduction in unnecessary hospital stays, emergency visits and complications, though the magnitude of those savings has yet to be determined.
However, results from the Medicare Shared Savings Program, CMS’ largest and longest-running alternative payment model, suggest there is significant potential to bring costs down. CMS reported $2.1 billion and $2.5 billion in net savings from the program in 2023 and 2024, respectively.
Researchers have also been proving connected devices’ ability to lower costs over the past decade. One recent study, published last year in the Journal of Cardiac Failure, found that remote patient monitoring for heart failure patients was associated with a 52% reduction in monthly healthcare costs, mainly by reducing hospital stays and adverse events like heart attacks.
And just last month, virtual care provider Cadence published a peer-reviewed study on its collaboration with Mayo Clinic, and it showed that the startup’s remote monitoring programs resulted in a 27% drop in hospital admissions.
Raising the bar on accountability
Fewer inpatient visits and shorter hospital stays are outcomes that directly lower spending on costly acute care, noted Cadence CEO Christopher Altchek. CMS is looking for ways to save money, which is why ACCESS fits into a broader policy shift, he stated.
He pointed to a couple of parallel developments — higher 2026 reimbursement for remote patient monitoring and advanced primary care management in CMS’ Physician Fee Schedule, as well as HHS’ $50 billion rural health transformation fund prioritizing chronic disease management.
In Altchek’s view, ACCESS will help raise the bar on accountability. Two implications stood out for him, the first being that CMS will publish annual standardized performance results, which will quickly separate high-quality participants from weaker ones.
The second is that clinical outcomes will be measured by improvement over time. For example, CMS will be paying attention to whether patients’ blood pressure or A1c is lower at the end of the program than it was at the beginning. Altchek said this is a more precise and meaningful approach than current CMS Star Ratings.
“The way Stars metrics are calculated is not detailed enough. A Stars metric is like what percentage of your hypertension population is under control — it doesn’t give you any credit for the movement within the population or how effective you are. It’s a very crude metric. This is a much more precise metric, and that’s really helpful to have — standardized at the level of CMS,” he explained.
Altchek said ACCESS could reset how payers and providers evaluate chronic disease management by creating an “apples-to-apples” standard for outcomes and cost savings.
ACCESS bets on digital care — but only if the data flows
In addition to raising the bar for accountability, ACCESS also sets higher standards for digital health providers, said Lark Health CEO Julia Hu. Lark offers a digital platform for chronic disease management and prevention.
Hu said she welcomes being held to stricter, outcomes-based standards and believes ACCESS could force underperforming digital health and AI vendors out while rewarding those that can prove their value.
She thinks that data integration will be the biggest challenge to adoption.
“How do we mesh the traditional [primary care provider] channels with these technologies to create a seamless experience for the patient while working through the clinical workflow so that providers can point to the correct services? I think that will be a challenge that we should all work on,” Hu remarked.
There is time, though. She pointed out that CMS has laid out a 10-year timeline for this project. This duration is critical, she said, because it gives providers time to mature and work through operational and integration challenges.
Another healthcare startup CEO — Jason Prestinario, CEO of data platform Particle Health — said that the model’s success will hinge on the ability to seamlessly share patient data across various providers and care settings.
He argued the model cannot work without seamless data flow across all those touchpoints. While there has been progress in nationwide data exchange, gaps remain — especially around individual access and persistent information blocking by EHR vendors, Prestinario noted.
“There’s going to be a lot of different sources of information, and ways and tools and technology that providers are going to use to holistically treat the patient — so we need to make sure that EHRs can’t block that access in ways that we still see today. I think we are making a lot of strides and a lot of improvements, but there’s still work to be done, for sure,” he declared.
Prestinario called for stronger enforcement on the “supply side” of data. He argued that CMS has focused heavily on stimulating demand for better data use through its initiatives aimed at improving personal data access and better clinician workflows — but that it has not done enough to ensure the supply of data is actually available.
He said value-based care models like ACCESS will only work if regulators more aggressively enforce information-blocking rules and require EHR vendors and providers to make patient data readily accessible when patients receive care across different settings.
Prestinario added that he expects the model to benefit value-based and digitally native providers first. He thinks providers that are already focused on outcomes — particularly in CMS’ target areas like cardiac disease, diabetes, behavioral health and musculoskeletal — will benefit most. He is less certain how commercial payers and Medicare Advantage will ultimately adapt, given that they have different incentive structures and typically lack standardized requirements around data sharing and outcomes measurement.
Ultimately, ACCESS could give Medicare the tools to pay for outcomes instead of volume — but its success will depend on how CMS follows through on measurement, enforcement and data sharing.
Photo: Charday Penn, Getty Images
