Clamoring for ACCESS: New CMS 10-year payment model gets more than 150 applicants

More than 150 health care organizations have applied to participate in the new ACCESS payment model of the U.S. Centers for Medicare & Medicaid Services (CMS).

ACCESS is short for Advancing Chronic Care with Effective Scalable Solutions. Medicare leaders hope participating organizations will improve health measures of patients with early cardio-kidney-metabolic function (eCKM), cardio-kidney-metabolic function (CKM), musculoskeletal (MSK) and behavioral health (BH) conditions.

On April 13, 2026, CMS announced it had accepted more than 150 organizations’ applications. The April 1 application deadline was extended to May 15 for organizations that want to start with the program’s July 15 launch nationwide. After that deadline, applicants will begin participating Jan. 1, 2027, for the 10-year program.

“What this model is focused on is how we can leverage new approaches to care for patients and reward the delivery of care that drives better outcomes,” said Abe Sutton, J.D., director of the CMS Innovation Center. He spoke during an interview with American Medical Association CEO John Whyte, M.D., M.P.H., for that organization’s Moving Medicine podcast.

A new approach to chronic care payment

At its core, ACCESS represents a shift away from traditional fee-for-service reimbursement. Rather than paying for a defined set or volume of services, the program issues monthly payments for managing qualifying conditions that are tied to measurable outcomes.

In the AMA podcast, Sutton described the model as a deliberate departure from Washington-defined reimbursement schedules.

"Let's get away from bureaucrats in Washington defining what we pay for in health care and instead say, we pay for outcomes," he said. Participating organizations choose which technologies and care pathways to deploy; CMS evaluates them on whether patients improve.

The model’s four clinical tracks cover conditions that together affect approximately two-thirds of Medicare beneficiaries. Cardio-kidney metabolic syndrome refers to the interconnected health risks involving the heart, kidneys and metabolism, including conditions such as diabetes, obesity and chronic kidney disease.

"We're experiencing a rising chronic disease burden in this country," Sutton said. "We want to halt and reverse that."

Payment now and later

The payment structure includes a 50/50 withhold: Half of each organization's outcome-aligned payment is distributed monthly, while the remaining half is released only when the organization meets defined outcome attainment thresholds. In the model's first year, that threshold requires at least 50% of an organization's patients to meet established clinical targets, according to payment details published by theaccessmodel.com, an online resource with analysis from health care technology company CareCo.

Technology: a tool, not a substitute

The model envisions technology not as a replacement for the physician-patient relationship, but as a tool to extend and support it. Sutton offered the example of a connected blood pressure cuff combined with a nutrition coaching application that tracks dietary intake and correlates it with the patient's readings, feeding that data back to the treating physician in real time or flagging urgent changes.

CMS is building data-sharing requirements into the model to address physician concerns about interoperability. Participating organizations will also have the option to waive the standard 20% Medicare coinsurance for patients enrolled in the model, which Sutton said could help expand access, particularly for cost-sensitive beneficiaries.

How is primary care involved?

The model primarily targets organizations that provide technology-supported chronic care services. Most primary care practices are unlikely to enter the ACCESS Model as direct participants, according to an analysis published in January 2026 by the American Academy of Family Physicians (AAFP).

However, the model creates a defined role — and possibly new revenue — for primary care and referring physicians, said the analysis from Erin Solis, AAFP manager, practice and payment. Once a physician refers a patient to an ACCESS Model participant and the patient enrolls, the participating organization must send regular progress updates to the referring clinician. Primary care physicians can then bill for reviewing those updates and coordinating associated care through a new co-management payment of approximately $30, billable once every four months — up to $100 per patient annually, according to the AAFP analysis. The payment is not subject to beneficiary cost-sharing.

Sutton suggested physicians explore which ACCESS-participating organizations are available in their area and consider beginning referral relationships through their commercial patient populations before expanding to Medicare. CMS plans to publicly post outcome data for all participating organizations, giving referring physicians a basis for evaluating which partners deliver results.

Requirements, guardrails and accountability

To participate in the ACCESS Model, all participating organizations must be enrolled in Medicare Part B as providers or suppliers and must comply with applicable licensure requirements, data privacy and security standards, outcome-reporting obligations and other quality measures established by CMS.

Whyte asked about potential downsides or challenges, and Sutton acknowledged the stakes for participating organizations.

“I think for the organizations that are organizing to participate in this, they really face a high-stakes situation, where if their improvement really drives better outcomes, it's a no-brainer,” he said. “But if they're not sure and if it doesn't, then they risk not achieving full payment.”

CMS will raise performance standards over time for organizations that remain in the model and will publish outcome data publicly. He said it could create market pressure for organizations to compete on results.

Private payer alignment and long-term goals

The ACCESS Model has drawn commitments from private payers. Health plans representing 165 million members across Medicare Advantage, Medicaid and commercial coverage have committed to aligning their payment approaches with the ACCESS Model, with many beginning that alignment this year, according to CMS.

Sutton described success over the model's 10-year horizon in two dimensions: better health outcomes for patients living with chronic conditions, and a measurable reduction in Medicare and Medicaid spending.

CMS has committed to iterating on the model based on real-world results, including annual data reviews, public reporting and listening sessions with participating physicians and organizations.