In May 2025, CMS’s Center for Medicare & Medicaid Innovation (CMMI) unveiled its “Make America Healthy Again” vision. CMMI models focus not only on “protecting the federal taxpayer” but also on (i) promoting evidence-based prevention, (ii) empowering people to achieve their health goals, and (iii) promoting choice and competition for people. CMMI has introduced several new alternative payment models to support this approach including:
- IOTA (Increasing Organ Transplant Access) Model: July 1, 2025 – June 30, 2031
- Generous (cost reductions for US Medicaid): January 1, 2026 – December 31, 2030
- ACCESS (Advancing Chronic Care with Effective Scalable Solutions) Model: July 5, 2026 – June 30, 2035
- GLOBE (Global Benchmark for Efficient Drug Pricing): October 1, 2026
- ASM (Ambulatory Specialty Model): January 1, 2027 – December 31, 2033
- Team (Transforming Episode Accountability Model): January 1, 2026 – December 31, 2030
- Forward (Achieving Health Care Efficiency Through Accountable Care): July 2025 – December 31, 2035
- Maha Elevate (Make America Healthy Again: Lifestyle Improvements: September 1, 2026
- LEED (Long-Term Advanced ACO Design) Model: January 1, 2027 – December 31, 2036
A recent AHLA article summarizes the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) model. Here’s an overview:
The Centers for Medicare & Medicaid Services (CMS) Innovation Center has launched the Access Model, an unprecedented 10-year nationwide program running from July 2026 to June 2036 that fundamentally reimagines how Medicare pays for chronic disease management. Instead of traditional fee-for-service billing, ACCESS is used Results-Aligned Payment (OAP) Which rewards healthcare providers for achieving measurable health improvements in patients with chronic conditions. Participants receive annual payments ranging from $90 to $420 per beneficiary depending on track (see 4 below) and care period (initial or follow-up), with full payment dependent on meeting clinical outcome goals and reducing duplicative services. Note, “Participants in the model accept the OAP methodology to achieve results for aligned beneficiaries Replacement for traditional FFS billing For services provided to these beneficiaries.” The model initially covers four clinical tracks: :
| Early Cardio-Kidney-Metabolic (eCKM) | High blood pressure (HTN), or two or more of the following conditions: 1) dyslipidemia, 2) obesity or overweight with markers of central obesity,* or 3) prediabetes. |
| Cardio-Kidney-Metabolic (CKM) | One or more of the following conditions: 1) diabetes mellitus, 2) chronic kidney disease (CKD) stage 3A or 3B, or 3) atherosclerotic cardiovascular disease (ASCVD) |
| Musculoskeletal (MSK) | Chronic MSK pain (ie, lasting >3 months) |
| Behavioral Health (BH) | One or more of the following conditions: 1) depression, or 2) anxiety |
The ACCESS model represents a significant change Technology-Enabled Care DeliveryProviding participants the flexibility to provide services through remote monitoring, virtual consultations, connected medical devices and FDA-approved software while maintaining nationally recognized clinical standards. A notable feature is the Technology-Enabled Meaningful Patient Outcomes for Digital Health Tools pilot (TEMPO pilot), which Allows digital health device manufacturers to obtain FDA enforcement discretion for devices that are not yet authorizedEnabling real-world data collection under controlled conditions. However, participants face significant restrictions, including restrictions on billing Medicare fee-for-service to aligned beneficiaries, which creates revenue challenges, especially for traditional health systems with multiple service lines. To encourage care coordination, the model introduces new co-management payments of approximately $30 that allow primary care physicians to bill for reviewing patient updates and coordinating with ACCESS participants.
This model presents opportunities for digital health companies, accountable care organizations (ACOs), and technology vendors who can partner with or participate directly with participants, although many Industry stakeholders have expressed concerns that payment rates are too low. To encourage widespread adoption given the necessary infrastructure investments (modern health care). Many commercial payers, including major insurers such as UnitedHealthcare, Cigna and Humana, have already paid Signed pledges to implement equitable outcome-aligned payment options (RAC Monitor), suggesting that this approach could become standard in both Medicare and private insurance. While the focus on outcomes and digital technology is a laudable goal, organizations considering participation must meet complex legal and operational requirements, including entity formation, Medicare enrollment, HIPAA compliance, FDA regulations for digital devices, and federal fraud and abuse laws.
The full article with more details is available to AHLA members here.
