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News
CMS is expanding its ACCESS model — a value-based payment program that pays digital health companies based on patient outcomes — to cover four additional chronic conditions starting spring 2027. Heart failure, COPD, substance use disorders, and tobacco cessation will join the existing lineup. With 160 organizations already on board, CMS estimates three out of four Medicare beneficiaries now qualify for at least one ACCESS track.
Just two months after launching, CMS is already expanding its ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model. The 10-year federal payment program — which reimburses digital health companies and providers based on measurable patient outcomes rather than services delivered — is adding four new clinical tracks: heart failure, COPD, substance use disorders, and tobacco cessation. The expansion kicks off in spring 2027, bringing the total number of covered conditions from four to eight.
The model is designed to reward real results. Participating organizations receive recurring payments only when Medicare enrollees hit defined health benchmarks — think improved blood pressure or lipid levels. CMS is also eyeing a much broader reach, with 17 health payers representing 165 million Americans across Medicare Advantage, Medicaid, and commercial plans pledging to adopt an aligned outcomes-based payment structure.
By the Numbers:
Why it matters: ACCESS represents a significant shift in how chronic disease management gets paid for — moving away from fee-for-service toward tech-enabled, outcome-driven care. If it scales as intended, it could reshape incentives across Medicare, Medicaid, and commercial insurance alike.
