The New Medicare ACCESS Model: Is Your Practice Ready for Technology-Supported Chronic Care?

How CMS’s shift toward outcome-aligned payment models will reshape chronic disease management, and what your practice needs to do now.

The way Medicare pays for chronic disease management is changing, and if your practice treats patients with hypertension, diabetes, chronic pain, or depression, it affects you directly.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center has been piloting a new direction in alternative payment models: outcome-aligned payments (OAPs) for chronic condition management. Rather than reimbursing for individual visits and procedures, these emerging models pay providers a recurring monthly amount to manage a patient’s condition over a 12-month period, with full payment contingent on achieving measurable health improvements.

The bottom line? If patients get better, practices get paid. If outcomes fall short, payments get reduced.

This blog breaks down exactly what the ACCESS Model is, which conditions it covers, how the payment structure works, what technology your practice needs, and how to decide whether participating is right for you.

What are outcome-aligned payment models? (And why they matter now)

The CMS Center for Medicare and Medicaid Innovation (CMMI) has spent the last decade testing alternative payment models, from the Medicare Shared Savings Program (MSSP) to ACO REACH, with a consistent goal: move Medicare away from paying for volume and toward paying for health outcomes.

The next frontier in that shift is outcome-aligned payments (OAPs) for chronic disease management. Rather than billing for individual office visits, OAP-based models pay providers a prospective monthly amount to manage a patient’s chronic condition continuously, with reconciliation at the end of a 12-month period based on whether defined clinical targets were met.

CMS has signaled clearly, through recent CMMI strategic refreshes and the Accountable Care Organization initiatives, that technology-supported chronic care management is a priority direction. Practices that build the right infrastructure now will be positioned to participate in these models as they expand, and to compete effectively in a Medicare landscape that increasingly rewards outcomes over activity.

Who this matters to:

• Primary care physicians and internal medicine specialists
• Cardiologists, endocrinologists, nephrologists, and orthopedic/pain specialists
• Behavioral health providers
• Digital health organizations and remote monitoring companies
• Practice administrators evaluating new revenue opportunities

The four chronic condition categories these models target collectively affect approximately two-thirds of all Medicare beneficiaries, making this one of the most significant payment shifts in recent memory.

From Fee-for-Service to Outcome-Aligned Payments, What’s Actually Changing

For decades, traditional Medicare has reimbursed providers for the volume of services delivered, office visits, procedures, labs. What it hasn’t reliably paid for is the continuous, proactive, technology-enabled care that keeps chronically ill patients healthier between visits. To understand why ACCESS is a big deal, it helps to see the contrast with traditional billing.

Digital tools like connected devices, telehealth platforms, and health apps have transformed how care can be delivered. But until recently, Original Medicare’s payment infrastructure hasn’t kept pace. Outcome-aligned payment models are designed to fix that.

Here’s how the two approaches compare:

Traditional Fee-for-Service	ACCESS Model (OAPs)
Pay per visit, procedure, or service	Flat recurring payment per patient per condition
Revenue tied to volume	Revenue tied to measurable clinical outcomes
Little incentive for between-visit care	Rewards proactive, technology-enabled management
No payment for remote monitoring (in most cases)	Explicitly supports telehealth, wearables, apps
Fragmented care episodes	Continuous 12-month care management model

Under the ACCESS Model, participating organizations receive prospective monthly payments, one-twelfth of an annual allowed amount, for as long as a patient is enrolled. At the end of the 12-month care period, CMS reconciles actual outcomes against targets.

This model gives clinicians much greater flexibility to deliver personalized, technology-supported care, using whatever tools and interventions work best, as long as those efforts translate to better outcomes.

Which Chronic Conditions Does ACCESS Cover? The 4 Clinical Tracks Explained

The ACCESS Model is organized into four distinct clinical tracks. Participating organizations can enroll in one or more tracks and must manage all qualifying conditions within each track they select. Patients can enroll at any point during the model’s performance period.

Track 1: Early Cardio-Kidney-Metabolic (eCKM)

Target Conditions:

Hypertension, dyslipidemia (high or abnormal lipids/cholesterol), obesity or overweight with a marker of central obesity, and prediabetes

This track focuses on early intervention, catching and managing the metabolic risk factors that, left unaddressed, progress to diabetes, heart disease, and kidney failure. Technology plays a key role here: remote blood pressure monitoring, digital weight tracking, and app-based lifestyle coaching are all well-suited to this population.

Annual allowed amount (Initial Period): $360 per patient

Track 2: Cardio-Kidney-Metabolic (CKM)

Target Conditions:

Diabetes, chronic kidney disease (stage 3a or 3b), and atherosclerotic cardiovascular disease (ASCVD), including heart disease

This is the most complex and highest-acuity track, reflecting the interconnected nature of advanced cardio-metabolic disease. Patients in this track often require close monitoring of A1c, blood pressure, LDL cholesterol, and kidney function markers, all areas where connected devices and digital care management have proven impact.

Annual allowed amount (Initial Period): $420 per patient, the highest of the four tracks

Track 3: Musculoskeletal (MSK)

Target Conditions:

Chronic musculoskeletal pain

Unlike the other three tracks, the MSK track is designed as an intensive one-year program with no Follow-On Period, aimed at achieving substantial and durable pain relief and functional improvement within that timeframe. Digital physical therapy, remote exercise coaching, and pain-tracking apps are natural technology fits here.

Annual allowed amount: $180 per patient

Track 4: Behavioral Health (BH)

Target Conditions:

Depression and anxiety

Behavioral health has historically been one of the most undertreated areas in chronic disease management, partly because traditional reimbursement models create barriers to continuous care. The ACCESS BH track addresses this gap by supporting technology-enabled mental health management, digital CBT tools, remote check-ins, and app-based symptom tracking, as part of a sustained care program.

Annual allowed amount (Initial Period): $180 per patient

• Important: Patients can be enrolled in more than one track simultaneously if they have qualifying conditions across multiple categories, and participating organizations can bill separately for each track.

How Much Will Practices Get Paid Under the ACCESS Model?

Payment under ACCESS is structured in two phases for most tracks: an Initial Period (the first 12 months of intensive management) and a Follow-On Period (ongoing maintenance care at reduced rates). Here is a full breakdown:

Annual Allowed Amounts by Track

Track	Initial Period	Follow-On Period
eCKM	$360	$180
CKM	$420	$210
MSK	$180	No Follow-On Period
BH	$180	$90

These amounts represent the total allowed amount, which includes both the 80% Medicare program share and the 20% beneficiary coinsurance. Participating organizations may uniformly waive the 20% coinsurance, a significant provision for ensuring low-income beneficiaries aren’t priced out of the program.

Payments are disbursed monthly at one-twelfth of the applicable annual allowed amount, providing consistent and predictable cash flow throughout the performance period.

Care Management Payment (CMP)

In addition to OAPs, clinicians, including referring physicians who are not direct ACCESS participants, can bill a Care Management Payment (CMP) of $30 per service, available up to three times per 12-month care period per beneficiary per track. A $10 onboarding modifier applies to the first claim. Geographic adjustments based on the Medicare physician fee schedule will affect actual payment amounts by location.

If a patient is enrolled in multiple tracks, CMPs can be billed for each — provided distinct review and coordination activities were documented for each track.

The 50% Outcome Attainment Threshold

For 2026–2027, CMS requires that at least 50% of a practice’s aligned beneficiaries meet all required outcome targets to receive full reconciliation payment. Outcome measures vary by track but generally include:

• Blood pressure control (eCKM, CKM)
• A1c and LDL levels (CKM)
• Weight and BMI (eCKM)
• Validated pain and function scores (MSK)
• Standardized depression and anxiety symptom measures (BH)

If a practice falls below the 50% threshold, CMS may reduce withheld payments proportionally.

What Technology Your Practice Needs?

Technology isn’t just encouraged under outcome-aligned payment models, it’s foundational to how they work.

FHIR-Based API Reporting

FHIR-based API reporting is required. FHIR (Fast Healthcare Interoperability Resources) is a standardized framework that lets different systems, EHRs, monitoring platforms, payer systems, exchange data in real time. If your EHR isn’t FHIR 4.0-compatible, this is the most critical gap to close before enrolling.

Technology-Supported Care Delivery

The ACCESS Model explicitly supports a range of digital health tools, including:

• Telehealth platforms (synchronous video visits and asynchronous messaging)
• Connected devices and wearables (remote blood pressure cuffs, glucometers, continuous glucose monitors, weight scales)
• Digital health apps (lifestyle coaching, medication adherence, symptom tracking, digital CBT)
• Remote patient monitoring (RPM) systems

Care can be delivered in person or virtually, including asynchronously, giving practices flexibility in how they build their care delivery model.

EHR Documentation Requirements

Practices must document in their EHR:

• Baseline assessments and outcome measures at enrollment
• Reviews of ACCESS care updates from other providers
• Communication to PCPs and referring clinicians at defined touchpoints (within 10 days of baseline, within 30 days of 12-month completion, and within 10 days of any escalation or transition)

Health-Related Social Needs (HRSN) Screening

Health-related social needs (HRSN) screening is also required. HRSN refers to non-medical factors, food insecurity, housing instability, transportation barriers, that significantly influence health outcomes. CMS increasingly requires their documentation and management in value-based care programs.

Practice readiness checklist

Before applying to participate in the ACCESS Model, use this checklist to evaluate your practice’s readiness across the key operational, clinical, and technology domains CMS requires.

Eligibility & Enrollment

• Enrolled as a Medicare Part B provider or supplier (TIN-based participation)
• Designated a Medicare-enrolled Medical Director for the organization
• Confirmed exclusion criteria do not apply (DMEPOS and laboratory suppliers are ineligible)

Technology Infrastructure

• EHR system supports FHIR-based API data submission
• Telehealth platform in place (synchronous and/or asynchronous)
• Connected devices or remote monitoring tools available for relevant track conditions
• Digital health app integration or partnership established (if applicable)

Clinical Operations

• Workflows established for HRSN screening
• Referral pathways to community resources documented
• Co-management communication protocols in place
• Staff trained on remote monitoring and digital health workflows
• Baseline assessment protocols defined per track

Financial & Compliance

• Decision made on whether to uniformly waive 20% beneficiary coinsurance
• Reviewed ACO/MSSP participation for compatibility (no conflict through 2027)
• CMS Model Interest Form completed to receive application updates

What referring PCPs should know

One of the most important and underappreciated aspects of the ACCESS Model is the role it creates for primary care physicians and referring clinicians who are not direct participants.

When a PCP refers a patient to an ACCESS Model participant and that patient enrolls, the participating organization is required to send the referring physician regular progress updates, including:

• A consented update within 10 days of baseline measures being established
• A completion summary within 30 days of the 12-month care period ending (or at earlier exit)
• An escalation or transition notice within 10 days of any significant clinical event

This communication requirement creates real transparency into how your patients’ chronic conditions are being managed, without adding administrative burden to your practice. It also positions referring PCPs to bill CMPs for their own coordination activities around ACCESS-enrolled patients.

ACO participants: what you need to know?

If your practice participates in a Medicare Shared Savings Program (MSSP) or an ACO REACH arrangement, the ACCESS Model is designed to be compatible. CMS has confirmed that ACCESS OAPs will have no impact on ACO benchmark and performance year calculations. ACCESS expenditures will be incorporated into ACO benchmarks, so ACO participants should plan for that alignment.

How to stay informed and apply

CMS publishes all active and upcoming alternative payment model opportunities through the CMS Innovation Center at innovation.cms.gov. To stay current:

• Monitor the CMMI website for new model announcements and request-for-applications (RFA) releases
• Subscribe to CMS Innovation Center email updates at innovation.cms.gov
• Review the Medicare Physician Fee Schedule final rule each fall for relevant payment policy changes
• Consult your health system, ACO, or practice management advisor about upcoming enrollment windows

Applications for active CMMI models are accepted through the CMS Innovation Center portal. There is no application fee, and participation is voluntary.

Should your practice participate?

Outcome-aligned payment models are a strong fit if you treat a high volume of Medicare patients with cardiometabolic, musculoskeletal, or behavioral health conditions; have a FHIR-compatible EHR; already use or are ready to implement telehealth and remote monitoring; and want predictable monthly revenue rather than purely episodic billing.

It may not be the right time if your EHR isn’t interoperable, you lack the workflows to support between-visit digital engagement, or your Medicare patient panel is small enough that the 50% outcome threshold becomes statistically difficult to achieve.

ACCESS is likely a strong fit for your practice if:

• You treat a high volume of Medicare patients with cardiometabolic, musculoskeletal, or behavioral health conditions
• Your EHR is FHIR-compatible or can be made so before your start date
• You already use or are prepared to implement telehealth, remote monitoring, or digital health tools
• You have (or can build) care coordination workflows that support continuous patient engagement
• You’re interested in predictable monthly payments rather than purely episodic billing

It may not be the right time if:

• Your EHR infrastructure is not yet interoperable
• You lack the staff or workflows to manage between-visit digital engagement
• Your patient panel is small, making the 50% outcome threshold harder to achieve statistically

The practices that invest now in FHIR-compatible EHRs, remote monitoring, and care coordination workflows will be positioned to enter each new CMS program on day one. January 2027 cohort applications are being accepted now at the CMS Innovation Center.

How OmniMD Helps Your Practice Get ACCESS-Ready

Meeting the Medicare ACCESS Model’s requirements isn’t a small lift, it demands a technology infrastructure that connects your EHR, telehealth, remote monitoring, and care management workflows into one seamless, outcome-driven system. That’s exactly what OmniMD is built to deliver.

OmniMD is a comprehensive healthcare technology platform with a portfolio of over 18 products spanning EHR, practice management, revenue cycle management, telehealth, and remote patient monitoring, purpose-built for chronic disease management across more than 20 specialties, including primary care, internal medicine, cardiology, nephrology, and behavioral health. Here is how OmniMD maps directly to what the ACCESS Model requires:

• FHIR-based EHR with real-time data exchange to CMS, specialists, hospitals, labs, and health networks ensures your practice meets the ACCESS Model’s mandatory interoperability requirements
• Integrated telehealth for synchronous video and asynchronous care, with specialty-specific configurations and direct EHR integration
• Remote patient monitoring with device data (blood pressure, CGM, weight scales, pulse oximetry) flowing directly into the clinical record in near real-time
• Chronic care management workflows and clinical decision support for every major track condition, including ASCVD risk scoring, CKD progression tracking, and validated behavioral health symptom measures
• AI-powered ambient documentation tools like AI Medical Scribe and AI Front-Desk  that reduces per-visit charting time by 40 to 60%
• Value-based care reporting services that align clinical performance tracking with outcome-linked payment requirements
• The bottom line: If the ACCESS Model is your destination, OmniMD is the platform that gets you there, covering every technology requirement CMS has outlined, across a single integrated system your team can deploy and scale.

Frequently Asked Questions

Can an ACO participate in the ACCESS Model?

Yes. The ACCESS Model is designed to complement ACO arrangements, not compete with them. CMS has stated that for 2026 and 2027, ACCESS OAPs will not impact ACO benchmark or performance calculations under the MSSP or ACO REACH. Beginning in 2028, ACCESS expenditures will be folded into ACO benchmarks, so ACO-affiliated practices should factor this into their long-term planning.

Does the ACCESS Model apply to Medicare Advantage (MA) patients?

No. ACCESS is being tested in Original Medicare (fee-for-service) only. However, CMS has noted that Medicare Advantage organizations may independently adopt similar outcome-aligned payment arrangements with their contracted providers.

What happens if my practice doesn’t hit the 50% outcome attainment threshold?

If fewer than 50% of your aligned beneficiaries meet their outcome targets during the performance period, CMS may reduce or withhold a portion of your reconciliation payments. The model is designed to measure performance at the organization level, not the individual patient level, so a robust patient population and strong care management protocols are important for financial sustainability.

Can patients be enrolled in more than one clinical track?

Yes. Patients with qualifying conditions in multiple tracks can be enrolled in more than one simultaneously. Participating organizations can bill OAPs and CMPs for each track, provided that distinct care management activities are documented for each.

What if I’m a specialist, can I participate without being a primary care practice?

Yes. Specialists who treat qualifying chronic conditions are eligible to participate. The model does not require you to be a primary care practice. However, you must be enrolled as a Medicare Part B provider and designate a Medical Director. Co-management communication with the patient’s PCP is a required operational element.

Is there a cost to apply?

There is no application fee. Participation is voluntary, and the only financial risk is the potential for reduced reconciliation payments if outcome targets are not met.

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