The Trump administration is rapidly expanding its 10-year ACCESS Model, a value-based payment program that reimburses digital health companies based on patient outcomes rather than services delivered.
Just two months after kicking off the program—called the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model—the Centers for Medicare and Medicaid Services (CMS) is extending it to more conditions.
CMS announced on Tuesday new ACCESS tracks for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders and nicotine dependence, along with extended support for bone, joint and mobility conditions.
The new condition tracks will start in spring 2027. The expansion significantly broadens the model's reach as CMS officials estimate that three out of four Medicare beneficiaries now qualify for at least one ACCESS track.
Unveiled in December, the ACCESS Model is a 10-year federal payment program from the Center for Medicare and Medicaid Innovation (CMMI) that gives digital health companies outcome-aligned payments for using technology and AI to manage chronic diseases. The program initially launched to provide stable, recurring payments for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety.
CMS leaders, including Administrator Dr. Mehmet Oz, framed ACCESS as a key component of the agency's effort to modernize healthcare through technology and AI, while rewarding providers and technology companies for measurable improvements in health outcomes. "ACCESS is one of the tools we are using to bring healthcare into the digital age, giving patients and their providers greater access to AI-enabled technologies, remote monitoring, connected devices, and other innovative tools that can help identify problems earlier and improve care. This latest expansion of the program will help more Americans get the care they need and reward providers who deliver actual results." Oz said in a statement.
There are now 160 organizations participating in the ACCESS model, and Medicare will continue to add to the list throughout the model’s 10 years.
"ACCESS is built to support care coordination. Coordinating clinicians, including primary care providers, specialists, rural and federally qualified health centers, pharmacies and more, can refer patients to ACCESS organizations, receive ongoing updates and bill for co-management," Jacob Shiff, chief AI and technology officer at CMMI, said during a CMS event on Tuesday. "ACCESS also works alongside risk-bearing arrangements that clinicians may already participate in, including ACOs, empowering them with more tools in their toolkit to manage cost and quality."
ACCESS supports people with Original Medicare. CMS said Medicare Advantage enrollees are not eligible, though their plans may offer similar programs.
But Shiff noted that the ACCESS model was designed "from day one" for impact beyond Original Medicare, "extending to Medicaid, Medicare Advantage and commercial plans."
"To make alignment easier, CMS is making available a set of optional resources other payers can adopt across contracting, including a sample provider agreement, billing with standardized billing codes and operations, including making CMS reporting infrastructure available to payers to support alignment and reduce payer and provider reporting burden," Shiff said.
CMS officials said 17 health payers representing 165 million Americans with MA, Medicaid and private health insurance plans have pledged to adopt an outcomes-based payment structure aligned to ACCESS, supported by CMS implementation resources.
That creates a "common approach across Medicare, Medicare Advantage, commercial, and state Medicaid programs," Shiff said.
"We are the payer of last resort for the Medicaid population. If you really think about it, they're the audience that needs the help the most and has the least backup system," Oz said during the CMS event.
Eighteen clinical and patient societies have also expressed support for the model.
CMS will also be publishing a reference specification for a maternal cardio-kidney metabolic track, including hypertensive disorders of pregnancy, as a voluntary reference that other payers, including Medicaid plans, can use to support cross-payer alignment.
"Ultimately, ACCESS is not just a model; it's a movement to rewarding better health outcomes for patients. It's about new personalized support for the most common chronic conditions connected to the providers covered by Medicare," Shiff said.
Oz said the ACCESS model "unleashes the technology community to work with the federal government to find better outcomes for the American people."
The CMS administrator also asserted that the use of AI can help address affordability issues in healthcare. "AI has the ability to assist physicians to do a better job taking care of you, help nurses manage chronic illnesses better, address some of the problems with navigation and transparency in the system in a way that is very empowering to the American people," he said.
The model encourages the use of tools like AI, remote monitoring, telehealth platforms, wearables and health apps.
"I think years from now, when you look back on it, you'll realize that was a sentinel moment. The release of the ACCESS model unleashes technology to work with the American people for the mutual benefit of improving our health. Let's not screw it up. We don't get two chances at this. If we don't handle the trust that's offered to the industry now to work collaboratively, and we end up with bad stories, that's very harmful to this process. If we get it right, it's going to be a beautiful symphony," Oz said.
Health and Human Services Secretary Robert F. Kennedy Jr. said a model to treat and manage chronic conditions based on outcome-aligned payments sets up the right incentives to encourage better preventive care.
Hospitals and healthcare organizations are "well-intentioned," he said, but noted that the fee-for-service payment system "pushes an incentive system that is rewarding them for keeping people sick."
"It is paying for tests and for hospital visits and for doctors' visits and for pharmaceutical drugs," he said. "Historically, we've paid doctors for therapy for people when they're sick without giving them any of the tools or incentivizing people to keep them healthy. We reward the volume of services delivered rather than improvements in health. When we pay for activity instead of outcomes, we get more activity. We do not necessarily get healthier patients. And when outdated payment rules stand in the way of prevention and innovation, they make it harder for doctors to invest in the things that can help people get healthy and stay healthy," Kennedy said during the CMS event.