CMS Expands ACCESS Model: What It Means for Chronic Care

CMS is expanding its ACCESS Model, a Medicare program designed to improve care for people with chronic health conditions. The program uses technology to help patients manage their health between doctor visits. It also changes how participating organizations are paid. Instead of focusing only on the number of services provided, ACCESS ties payment to improvements in patient health. According to Fierce Healthcare, CMS is now expanding the program to cover more chronic conditions and is looking at ways the ACCESS approach could eventually reach people outside Original Medicare.

What Is the ACCESS Model?

ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. The program is currently for qualifying people with Original Medicare. It gives healthcare organizations more ways to use technology to help patients manage chronic conditions.

This can include:

Technology	Description
Virtual Care	Remote consultations and healthcare services.
Remote Patient Monitoring	Tracking patient health data remotely.
Health Coaching	Personalized guidance for managing health.
Connected Health Devices	Devices that collect and share health data.
Digital Health Tools	Apps and platforms supporting patient care.
Other Technology	Solutions that help patients manage their conditions.

The goal is simple: help people better manage chronic health problems and reward organizations when patients achieve measurable health improvements.

CMS Is Adding More Chronic Conditions

ACCESS originally focused on common conditions such as diabetes, high blood pressure, chronic kidney disease, obesity, depression and anxiety. CMS is now expanding the model to include conditions such as heart failure, COPD, substance use disorders and tobacco use. CMS is also expanding support for chronic bone, joint and mobility conditions. The new tracks are expected to begin in 2027. CMS says about three out of four people with Medicare now qualify for at least one ACCESS track. That means the program could potentially reach a large number of Medicare patients.

More Than 160 Organizations Are Participating

Interest in ACCESS is already significant. CMS currently lists more than 160 healthcare organizations participating in the program. The list includes medical groups, specialty practices, chronic care organizations, ACO-related organizations and technology-enabled healthcare companies. These organizations are using ACCESS to test new ways of managing chronic disease.

Paying for Better Results

One of the biggest differences with ACCESS is how organizations can be paid. Traditional healthcare payments often focus on visits, tests and other services. ACCESS focuses more on results.

For example, depending on the condition, organizations may work toward improvements in:

Health Metric	Ways to Improve
Blood Pressure	Reduce sodium intake, exercise regularly, maintain a healthy weight, manage stress, and follow prescribed treatments.
Blood Sugar	Eat balanced meals, limit added sugars, increase physical activity, monitor glucose, and follow diabetes care recommendations.
Weight	Follow a balanced nutrition plan, increase physical activity, improve sleep, and establish sustainable lifestyle habits.
Cholesterol	Reduce saturated fats, increase fiber, exercise regularly, maintain a healthy weight, and take medications when prescribed.
Pain	Use appropriate physical therapy, gentle exercise, stress management, and clinician-recommended pain treatments.
Physical Function	Improve strength, flexibility, balance, and mobility through regular exercise, rehabilitation, and physical therapy.
Mental Health	Practice stress management, maintain social connections, prioritize sleep, exercise regularly, and seek professional support when needed.

This creates a stronger reason for healthcare organizations to understand each patient's health conditions and monitor them over time.

Could ACCESS Expand Beyond Original Medicare?

For now, ACCESS is an Original Medicare program. Medicare Advantage members aren't directly eligible for the Medicare ACCESS benefit. However, the ideas behind ACCESS could spread. CMS says health plans representing about 165 million people across Medicare Advantage, Medicaid and commercial insurance have pledged to offer payment approaches that follow similar ACCESS principles. That could make outcomes-based chronic care increasingly important across healthcare—not just Original Medicare.

Better Chronic Care Starts With Better Information

New technology can help healthcare organizations manage chronic conditions, but providers still need accurate information about their patients. That information can be difficult to find and providers and coders may have to search through a large medical record to find the information they need. Important details may be spread across doctor's notes, hospital records, specialist reports, lab results, medications, and diagnostic reports.

ForeSee Medical's ESP® platform uses AI to review patient information and identify chronic conditions that are supported by the medical record. Instead of searching through the entire chart, providers and coders can quickly see relevant information. With InstaVu®, users can click directly to the source document and see the supporting evidence highlighted. ForeSee's Compliance Module also reviews chart-note documentation for potential gaps. It helps providers see when documentation may need to be improved to properly support a diagnosis. This can help healthcare organizations:

• Find supported chronic conditions

• Spend less time reviewing charts

• Quickly see the clinical evidence

• Improve documentation

• Support accurate coding

• Strengthen compliance

Blog by: The ForeSee Medical Team