The latest development with the Centers for Medicare and Medicaid Services’s (CMS’s) ACCESS payment model is the agency announcing it has accepted 150 applicants to join the program, which aligns Medicare payment with measurable health outcomes.

The acronym ACCESS stands for the Advancing Chronic Care with Effective, Scalable Solutions program. CMS’s Innovation Center launched ACCESS to expand access to technology-supported care for obesity, diabetes, musculoskeletal pain, and depression patients on Original Medicare.

In addition to the applicant news, CMS said it is also extending the application deadline to apply to May 15. Applications received after this date will be considered for a start date of Jan. 1, 2027. ACCESS will run for 10 years beginning July 5.

CMS said people with Original Medicare have limited access to technology-supported care services for managing their chronic conditions because of Medicare payment barriers. This is where ACCESS comes in with the agency saying the new model will enable clinicians to offer innovative technology-supported care that improves patients’ health and complements traditional care.

Tech at the Fore

For Jay Gormley, chief investment officer and COO, Advisory, Zimmet Healthcare Services Group, the ACCESS model is not really designed for traditional providers. Instead, it is built to leverage technology and AI to bring virtual, tech-enabled services (many of which are already being used in the commercial or out-of-pocket population) into Medicare fee-for-service in a more outcomes-driven way.

“Payment is tied to outcomes, so participants only earn the full amount if they demonstrate measurable clinical improvement. This structure moves away from volume-driven reimbursement and toward a system where providers are accountable for results over time,” he said.

“A critical feature of the model is that it replaces fee-for-service billing for the participating organization. Once a patient is aligned to an ACCESS participant, that organization and its affiliates cannot bill Medicare fee-for-service for that patient during the care period. They are paid exclusively through the model’s outcome-aligned payments. This creates a defined financial envelope for managing the condition and forces participants to operate within it.”

Gormley said it also prevents duplicative billing and ensures that the model functions as a true alternative payment system rather than an add-on.

Chronic Disease in Crosshairs

Eric Palm, chief growth officer, Provider Partners, said his company is going to apply to the ACCESS model for Jan. 1, 2027.

“This is to start moving away from billing CCM codes [which hurts accountable care organizations (ACOs) usually in long-term care]. In ACCESS, we would be paid directly from Medicare, so this allows us to provide technology without hurting the ACO,” Palm said.

He said as CMS moves decisively toward outcome-aligned payment models like ACCESS, SNF operators can no longer afford to view chronic disease management as someone else's responsibility.

“The residents we care for every day — those living with diabetes, hypertension, and depression — are exactly the population this model is designed to serve, and SNFs that align with partners participating in ACCESS will be better positioned in an increasingly value-driven referral environment."

It’s important to note that ACCESS signals a fundamental shift in how CMS expects chronic care to be delivered — paying for outcomes, not activities. For SNF operators that means your care management partners matter more than ever, he said.

“Aligning with organizations participating in ACCESS isn't just good clinical practice; it's a strategic imperative as the industry moves toward technology-enabled, outcome-accountable care,” Palm said.

Payment Structure a Key

The payment structure is one of the most important aspects of the model, Gormley said, and is where the economics become clear.

“Payments are set on an annual, per-beneficiary basis and vary by track to reflect relative acuity and expected resource needs”, he said. For the initial period, which covers onboarding, care plan development, and early clinical improvement, payments are approximately $360 per year for the eCKM (early cardio-kidney-metabolic) track, $420 for the CKM (cardio-kidney-metabolic) track, and $180 for both the MSK (musculoskeletal) and BH (behavioral health) tracks.

“For tracks that include an ongoing management phase, the follow-on period payments are roughly half of the initial amounts, at about $180 for eCKM, $210 for CKM, and $90 for BH. The musculoskeletal track does not include a follow-on period and is structured more as a one-time episode focused on achieving functional improvement,” Gormley said.

Modest Indeed

He notes that these payments are per year, not per month, and they are not 100 percent guaranteed since there are performance components in play.

“These payment levels are really modest, which is intentional. They assume that participants will rely on scalable, technology-enabled care models rather than traditional, high-touch service delivery,” Gormley said.

“Payments are not simply paid out evenly without accountability. They are distributed monthly, but only a portion is paid prospectively. Roughly half of the total payment is effectively withheld and reconciled at the end of the care period based on performance. To earn the full payment, participants must meet outcome thresholds across their patient population.”

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.