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News
CMS is doubling down on its ACCESS Model, expanding the value-based payment program to cover heart failure, COPD, substance use disorders, and nicotine dependence—just two months after launch. The program, which pays digital health companies based on patient outcomes rather than services, now has 160 participating organizations. With three out of four Medicare beneficiaries qualifying for at least one track, this marks a significant shift in how chronic care gets paid for.
Just two months after launching, CMS's ACCESS Model is already getting a major upgrade. The agency announced new condition tracks covering heart failure, COPD, substance use disorders, and nicotine dependence, with expanded support for bone, joint, and mobility conditions set to kick off in spring 2027. The program—short for Advancing Chronic Care with Effective Scalable Solutions—pays digital health companies based on measurable patient outcomes rather than the volume of services delivered, a significant departure from traditional fee-for-service models.
The ambition here goes well beyond Medicare. CMS is actively courting other payers to align with the ACCESS framework, offering standardized billing codes, sample provider agreements, and shared reporting infrastructure to reduce administrative burden across the board.
By the Numbers:
Why it matters: ACCESS represents one of the most sweeping federal bets on AI and digital health tools to manage chronic disease at scale. If cross-payer alignment takes hold across Medicare, Medicaid, Medicare Advantage, and commercial plans, it could fundamentally reshape incentives across the entire U.S. healthcare system—rewarding outcomes over activity.
