Medicare’s experiment in paying tech companies to manage chronic conditions has barely gotten underway, and CMS is already making it bigger.
Advancing Chronic Care with Effective, Scalable Solutions. ACCESS launched in July to get more companies to lean in on Medicare by rewarding them for using technology to manage diabetes, hypertension, chronic musculoskeletal pain, depression, and anxiety.
- The model’s core mechanism for accomplishing that is Outcome-Aligned Payments (OAPs), which pays providers more if their patients’ conditions improve.
- The catch is that these OAPs were “set low” in an effort to encourage innovation that reduces reliance on clinicians, with maximum yearly OAPs ranging from $180 per patient for behavioral health to $420 for cardio-kidney-metabolic conditions.
New tracks are now set to kick off spring 2027. CMS announced that it’s expanding the number of conditions eligible for ACCESS to include substance use disorder, heart failure, COPD, tobacco use, and longer-term support for MSK conditions (a big question mark when the initial model debuted).
- Put it all together, and about 3 in 4 Medicare beneficiaries will reportedly be eligible for at least one of the tracks.
Who’s participating? Medicare was kind enough to publish the answer in a shiny new directory of providers who can take patients under ACCESS – 39 in total – only a small slice of the 150 companies that were provisionally accepted earlier this year.
- In: Whoop, Withings, Welldoc, Cadence, and a lengthy roster of smaller players.
- Out: Omada, Sword, and Hinge, all powerhouses in the chronic condition management space that said the OAP caps wouldn’t support their clinician-heavy models.
Commercial payers are also on board. Although ACCESS is Medicare-only, CMS’s chief AI and technology officer said 17 major health plans covering 165M lives have committed to adopt ACCESS-aligned approaches by 2028, including UnitedHealthcare, Humana, Cigna, and Centene. That’s some real scale if they follow through.
The devil’s in the details. Critics worry ACCESS vendors will fragment care if they don’t loop in primary care, so the model requires PCP outreach and offers small coordination payments.
- The expansion also landed one day after comments closed on the 2027 MPFS, which proposes cutting RPM reimbursement because vendor-delivered services fragment care – the exact same thing that ACCESS invites.
The Takeaway
CMS is sticking to its agenda. It wants to pay less for chronic care, and it wants to pay it to whoever can deliver outcomes without a clinician on every call. Whether $420 a year actually gets you better outcomes is now a live experiment with 39 participants.