CMS Added Five Tracks to ACCESS. The Payer Pledge Covers 165 Million People Who Cannot Join It.
- CMS is expanding the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model from spring 2027 with tracks for heart failure, COPD, substance use disorders and tobacco cessation, plus extended musculoskeletal support beyond the initial 12-month care period. Existing tracks cover high blood pressure, diabetes, chronic musculoskeletal pain and depression.
- The model pays on outcomes rather than services, tying payment to measurable improvements in patient health. Participants may provide virtual care, health coaching, remote monitoring, and connected devices and wearables between appointments, with referral routes from primary care.
- 160 organisations are participating at launch, with CMS adding more across the model’s 10-year run and maintaining a public directory. CMS states that 3 out of 4 people with Medicare qualify for at least one track.
- Eligibility is limited to Original Medicare. Medicare Advantage enrollees cannot participate, though their plans may run similar programmes. Separately, payers representing 165 million Americans across Medicare Advantage, Medicaid and commercial insurance have pledged to adopt an outcomes-based payment structure aligned to ACCESS, and 18 clinical and patient societies have expressed support.
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The expansion is the announcement. The number worth holding is 165 million, and those people are covered by plans that are not eligible for the model the pledge is aligned to.
- The pledge is larger than the programme and points somewhere else. ACCESS serves Original Medicare only, while the payers pledging alignment cover Medicare Advantage, Medicaid and commercial lives. CMS is using a 10-year demonstration to set a payment template for markets the demonstration does not touch.
- Outcomes-based payment moves the evidence burden onto the vendor. Payment ties to measurable improvement rather than services delivered, so a remote monitoring or connected device company is selling a result, not a device. Any product entering these 5 new tracks needs an outcome it can be paid against before it needs a sales team.
- Substance use disorder is the track to watch. It covers opioid, alcohol and other substance use disorders with integrated support for co-occurring depression and anxiety, a benefit where digital delivery has struggled to get paid. A 2027 start is the first durable reimbursement route many of these vendors will have had.
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CompaniesCMS
GeographyUnited States