The 10-year voluntary model aims to provide original Medicare beneficiaries with new options to improve their health and prevent and manage chronic diseases with technology-supported care. It also is a direct competitive tactic that could erode Medicare Advantage's entire value proposition, says one industry expert.
The Centers for Medicare & Medicaid Services (CMS) announced Monday the launch of a new care model that will offer Medicare members more choices to manage their chronic conditions, such as high blood pressure, diabetes, chronic musculosketal pain, and depression.
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model aims to address the needs of people with original Medicare who have limited access to modern, technology-supported care for managing their conditions.
CMS intends to pay participating clinicians with fixed amounts in installments to manage patients’ conditions, but they will only receive the full amount if patients meet the required clinical outcomes. The agency said the focus on outcomes provides clinicians greater flexibility to deliver modern technology supported care that improves patient health.
The model will focus on clinical improvement or control of a condition based on the patient’s starting point. For example, CMS will reward providers for helping a patient with hypertension lower their blood pressure by 10 mmHg.
The model will focus on four clinical tracks:
- Early cardiometabolic conditions: hypertension (high blood pressure), dyslipidemia (abnormal or elevated lipids including cholesterol), obesity or overweight with marker of central obesity, and prediabetes.
- Cardio-kidney-metabolic conditions: diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease, including heart disease.
- Musculoskeletal conditions: chronic musculoskeletal pain.
- Behavioral health conditions: depression and anxiety.
CMS may consider additional tracks and conditions in the future.
Participating ACCESS care organization will be expected to offer patients integrated, technology supported care, such as clinical consultations; lifestyle and behavioral support (nutrition, exercise, smoking cessation; therapy and counseling; patient education and ordering and interpreting diagnostic tests and imaging; or use or monitoring of Food and Drug Administration authorized devices;
Providers may offer care in-person, virtually, asynchronously, or through other technology-enabled methods as clinically appropriate, CMS said.
CMS will accept applications to participate in the model beginning January 12, 2026, through April 1, 2026. The model will begin July 1, 2026. The agency will have request for applications available soon. Meanwhile, providers can complete the ACCESS Model Interest Form to be notified when the application becomes available.
Industry reaction
Medicare Advantage plans should play close attention to the latest model, industry expert Melissa Newton Smith, founder, senior advisor at Newton Smith Group, told RISE. She referred to the model as a direct competitive tactic that could erode Medicare Advantage's entire value proposition.
Indeed, the new model is a loud warning shot across the bow to Medicare Advantage plans still playing the game of manufactured profits without managing and orchestrating real care, she says.
In a LinkedIn post, Smith said that “Medicare Advantage plans that still struggle to embrace the next generation of Medicare Advantage that CMS is advancing through Stars redesign, this development (alongside the WISeR strategy in traditional Medicare) should be rapidly added as a potentially existential threat within your strategic plan.”