The ACCESS Model: How CMS’s New Framework Builds on Today’s Digital Care Programs

Key Takeaways 

• The ACCESS Model is a new CMS outcome-based care program that rewards measurable improvement in chronic conditions rather than traditional fee-for-service activities.
• ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) strongly emphasizes technology-enabled chronic care, including connected devices, remote monitoring, virtual care, and continuous patient engagement.
• RPM and CCM remain separate Medicare programs, but organizations already delivering remote patient monitoring and chronic care management are well positioned for ACCESS because the required digital infrastructure and workflows overlap.
• Primary care providers play a central role in ACCESS, supported by electronic care updates and a new co-management payment that strengthens coordinated, team-based chronic care.
• ACCESS represents a major opportunity for providers transitioning to value-based care, offering a scalable pathway to improve chronic disease outcomes using modern digital health tools and care-management models.
  
  

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The Centers for Medicare & Medicaid Services (CMS) has announced it will launch a new payment model that accelerates its transition from fee-for-service (FFS) reimbursement toward value-based care models that reward better outcomes, stronger patient engagement, and lower total cost of care. The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model shows CMS’s push for continuous, proactive chronic care rather than episodic office visits while also increasing the demand for solutions that help providers intervene earlier and support patients continuously between encounters.

ACCESS represents the next step in CMS’s push toward continuous, technology-enabled chronic care — an evolution made possible by the foundation laid through earlier digital-care initiatives. Remote patient monitoring (RPM) and chronic care management (CCM) have grown rapidly in recent years because they meet these needs for ongoing, digitally supported chronic care. RPM captures real-time trends and risk signals. CCM provides structured monthly support, medication management, and patient education. CMS also introduced advanced primary care management (APCM) in the 2025 Physician Fee Schedule final rule, further reflecting CMS’s interest in tech-supported, continuous care. While these programs remain under FFS billing, they have helped organizations build the infrastructure, workflows, and digital competencies needed to deliver modern chronic care.

CMS’s new ACCESS Model builds on similar principles, but introduces something entirely new: a flexible, outcomes-driven payment structure designed specifically for technology-enabled chronic disease management. ACCESS is not an extension of CMS’s RPM, APCM, or CCM programs. Rather, it is a distinct opportunity that rewards clinical improvement itself rather than activities, minutes of service delivery, or device usage. Still, organizations experienced in digital chronic care delivery will find themselves well positioned for ACCESS because the model encourages many of the same functional capabilities.

Understanding the ACCESS Model

ACCESS is a 10-year nationwide demonstration beginning July 1, 2026. CMS will accept applications on a rolling basis from January 2026 through 2033.

The model introduces outcome-aligned payments (OAPs), which are recurring payments tied to whether patients improve in guideline-based measures. CMS highlights that: “The model focuses on clinical improvement or control of a condition based on each person’s starting point, for example, helping a patient with hypertension lower their blood pressure by 10 mmHg."

This represents a fundamental shift. Instead of paying for specific services or for the amount of time spent on care coordination, CMS is testing whether paying for achieved results can expand access, improve outcomes, and reduce total spending.

ACCESS focuses on four chronic condition tracks:

• Early cardio-kidney-metabolic (eCKM)conditions: hypertension (high blood pressure), dyslipidemia (high or abnormal lipids, including cholesterol), obesity or overweight with marker of central obesity, and prediabetes

• Cardio-kidney-metabolic (CKM) conditions: diabetes, chronic kidney disease (3a or 3b), and atherosclerotic cardiovascular disease, including heart disease

• Musculoskeletal (MSK) conditions: chronic musculoskeletal pain

• Behavioral health (BH) conditions: depression and anxiety

Participating organizations must be Medicare Part B enrolled, designate a physician clinical director, meet HIPAA and FDA requirements, and report outcomes through CMS APIs. Patients may enroll directly with ACCESS organizations or join after referral. They may also participate in multiple tracks across different organizations.

To support continuity, ACCESS participants must share electronic care updates with primary care clinicians, who may bill a new co-management payment for reviewing updates and documenting care-coordination actions.

ACCESS and Digital Chronic Care: How They Relate

ACCESS establishes a new category of chronic care delivery that draws heavily on digital tools, remote support, and continuous engagement. Although RPM, CCM, and APCM continue to operate separately under FFS billing, the competencies required for successful digital care programs overlap substantially with what ACCESS expects from participating organizations.

ACCESS encourages:

• Use of connected devices and remote physiological data
• Regular communication and follow-up
• Behavioral and lifestyle support
• Ongoing care coordination
• Continuous assessment of each patient’s progress from baseline
• Strong documentation and standardized reporting

These expectations resemble the operational infrastructure that RPM, CCM, and APCM programs already rely on. For organizations with established digital care workflows, ACCESS should feel like a natural extension because the underlying care philosophy is similar.

Where ACCESS Stands Apart From Existing Digital Care Management Programs

Despite these shared foundations, ACCESS introduces a fundamentally different payment structure and care model:

• As noted, RPM, CCM, and APCM are tied to FFS rules, while ACCESS is an Innovation Center model with payments based on outcomes.

• RPM reimburses for remote monitoring and device-based data transmission. ACCESS does not pay for monitoring activity; it pays for improvement.

• CCM reimburses for documented care-management time. ACCESS payments are not based on minutes or encounter volume.

• RPM, CCM, and APCM are defined Medicare benefit categories. ACCESS is a new service category that blends remote care, coaching, device use, and clinical oversight with flexibility in exactly how organizations design and deliver their model so long as outcomes are met.

ACCESS is best understood not as a replacement or extension of RPM/CCM/APCM but as an entirely new pathway for delivering technology-enabled chronic care at scale.

Why Organizations With Digital Care Experience Are Well Positioned for ACCESS

While ACCESS is distinct, providers offering RPM, CCM, and APCM already have many of the building blocks that will support success in the model, including:

• Connected device workflows

• Care-management infrastructure

• Patient engagement and follow-up processes

• Data-driven care-plan adjustments

• Clinical escalation pathways

• Documentation and compliance frameworks

• Digital communication capabilities

These capabilities make it easier to launch and operate ACCESS programs that can achieve consistent clinical improvement.

ACCESS also creates an opportunity for organizations to evolve beyond traditional FFS digital care and build a more comprehensive, outcome-oriented chronic care model that supports multiple conditions, flexible modalities, and longer-term engagement.

The Bottom Line on the New CMS ACCESS Model

To summarize, ACCESS reflects CMS’s commitment to scalable, technology-enabled chronic care. It rewards measurable improvement, encourages modern digital care approaches, and supports ongoing engagement rather than episodic encounters. It is not part of RPM, CCM, or APCM. It is a new model that benefits from the digital care evolution underway across the provider landscape.

Organizations that have invested in remote monitoring, care management teams, digital engagement tools, and integrated care workflows are already partway toward what ACCESS will require. For these organizations, ACCESS represents a significant opportunity to expand capabilities, reach more patients, and participate in the next major chapter of Medicare’s value-based care strategy.

Learn How Your Organization Can Prepare for ACCESS

Prevounce equips healthcare organizations with turnkey chronic care technologies and services that support continuous, measurable improvement in patient health. Our unified platform simplifies remote data capture, care coordination, engagement, documentation, and reporting — all core components for building ACCESS-ready care pathways.

As CMS advances value-based care through models like ACCESS, the ability to deliver consistent, technology-supported chronic care has never been more important.

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