Why the CMS ACCESS Model matters for your practice

Medicare innovation set to transform chronic care management with digital health tools

More than two-thirds of Medicare beneficiaries live with chronic conditions; but to receive care, patients must navigate dozens of disconnected systems while providers struggle to access the comprehensive data they need.¹ The Centers for Medicare & Medicaid Services (CMS) has decided it’s time for a new approach. “What if we dream big and try to do something to change this?” asked Amy Gleason, Acting Administrator of the US DOGE Service and Strategic Advisor to CMS, in a webinar with athenahealth.² It’s the question at the core of Medicare’s most significant transformation in decades.

The CMS Health Tech Ecosystem is a collaborative effort involving over 600 organizations committed to modernizing healthcare delivery.³ This transformation addresses a critical challenge: while patients navigate dozens of disconnected systems, providers struggle to access comprehensive data needed for effective chronic care management.

“We’ve made things electronic, but in a lot of cases, we’ve just digitized bad processes,” Gleason explained during a recent conversation with athenahealth’s Vice President of Government & Regulatory Affairs, Joe Ganley. The solution requires moving beyond traditional regulatory approaches toward collaborative innovation that adapts at the speed of modern technology.

The newly introduced ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model represents the centerpiece of this transformation. For the first time in Medicare’s history, technology companies can register as direct Medicare Part B providers, earning reimbursement for achieving measurable health improvements rather than delivering traditional medical services.⁴

This shift from paying for services to paying for outcomes addresses what CMS identifies as the core challenge in chronic disease management: the need for continuous, personalized care extending far beyond traditional office visits. ACCESS creates financial incentives for the ongoing, technology-enabled engagement chronic conditions require.

The ACCESS Model: Transforming chronic care delivery

ACCESS introduces a revolutionary payment structure that compensates technology-enabled care providers based on achieving specific health outcomes for Medicare beneficiaries. The model has three main components:

1. Four targeted chronic condition tracks

ACCESS focuses on conditions driving significant Medicare spending: diabetes, hypertension, musculoskeletal pain, and behavioral health disorders. Gleason emphasized CMS selected these conditions based on “where we think technology can really make a difference.”

2. Technology-enabled care requirements

Participating organizations must demonstrate three capabilities: continuous patient engagement through digital platforms that provide regular interaction beyond traditional appointments; outcome measurement tracking of specific health metrics; and clinical integration that provides healthcare providers quarterly care plan updates.

“This is about engaging patients regularly to change behavior and drive outcomes,” Gleason explained.

3. Provider partnership model

Rather than competing with healthcare providers, technology companies leverage existing clinical relationships to become preferred ACCESS partners. Licensed providers remain responsible for overall patient care, while earning financial incentives of up to $100 per patient per year for referrals. 

The 10-year ACCESS timeline provides stability for investing in ACCESS-aligned capabilities while allowing early participants to shape requirements and payment structures.

The broader CMS Health Tech Ecosystem strategy

The ACCESS Model operates within CMS’s broader Health Tech Ecosystem — a comprehensive strategy designed to solve healthcare’s most persistent technology challenges. This ecosystem tackles three critical areas that have long hindered care delivery, creating the foundation that makes innovative models like ACCESS both feasible and scalable.

Infrastructure modernization foundations

Three foundational initiatives create the technical infrastructure for advanced care models: a National Provider Directory that eliminates the administrative burden of maintaining multiple databases; streamlined identity verification that reduces redundant requirements; and enhanced interoperability standards that enable exchange.⁵

“Kill the Clipboard” patient experience transformation

The “Kill the Clipboard” initiative allows patients to digitally share their health records with providers via QR codes, ending the need to fill out the same medical history forms at every appointment. This eliminates the need for patients to repeatedly recall and write out their medical history at every encounter, with providers committed to returning visit records to patients in the same secure format.⁶

“We want patients to walk into any healthcare setting and have their information just work,” Gleason noted.

Rural Health Transformation Fund

The $50 billion Rural Health Transformation Fund targets broadband infrastructure, technology platform implementation, telehealth expansion, and workforce development in underserved communities where traditional market forces have failed to drive technology adoption.⁷

How ACCESS leverages the ecosystem for practice transformation

ACCESS builds on these ecosystem foundations to create transformative opportunities for clinical practice:

Dual revenue stream opportunities

ACCESS introduces hybrid payment that allows practices to maintain existing fee-for-service revenue while accessing new outcomes-based payments. This addresses provider concerns about abandoning proven revenue models for untested value-based arrangements.

Administrative efficiency through technology integration

Automated patient monitoring shifts routine tasks from clinical staff to technology systems. Exception-based reporting means providers receive alerts only when intervention is needed, rather than reviewing routine normal values.

Patient engagement transformation

ACCESS enables continuous chronic disease management through daily patient interaction via technology platforms, behavioral change support through engagement tools, and real-time monitoring that enables proactive intervention.

Scalability for independent practices

The ecosystem approach addresses resource constraints that prevent smaller practices from implementing comprehensive chronic disease management. Technology providers offer platforms at no cost to referring practices, with integration through existing clinical systems that avoids new software implementation.

Technology-enabled chronic care in practice

ACCESS transforms theoretical concepts into practical, technology-driven interventions integrating with existing workflows:

• Diabetes management combines continuous glucose monitoring with AI-driven treatment adjustments and personalized coaching.
• Hypertension control creates comprehensive cardiovascular risk management through remote monitoring and medication optimization algorithms.
• Pain management delivers digital therapeutics combining movement analysis with behavioral interventions.
• Mental health support addresses psychological factors through conversational AI and mood tracking applications.

The ecosystem approach ensures seamless data flow through standardized APIs that integrate automatically into electronic health records, eliminating data isolation while supporting care coordination.

Strategic implications for healthcare stakeholders

ACCESS creates transformative opportunities across the healthcare ecosystem. Healthcare providers gain enterprise-level chronic care capabilities without traditional capital investment barriers, while technology vendors receive unprecedented Medicare market access through outcomes-based that aligns vendor success with patient health improvements. For patients, ACCESS transforms chronic disease management from episodic office visits to continuous engagement with personalized interventions and real-time monitoring.

This represents a significant shift in healthcare policy from regulatory barriers that limit technology adoption to collaborative innovation frameworks that actively support digital health integration. CMS is moving from cautious oversight to active partnership in developing technology-enabled care delivery models, creating precedents for future healthcare innovation programs.

Watch the full conversation between Amy Gleason and Joe Ganley, athenahealth’s Vice President of Government & Regulatory Affairs.