Health care leaders are planning around Medicare's ACCESS model but doubt it will pay off

Seventy-two percent of value-based care leaders say Medicare's new Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model is changing their technology strategy, but 59% either don't see its co-management payments as a meaningful funding source yet or say it's too early to tell, according to a survey released Oct. 12.

The National Association of ACOs (NAACOS) and health care artificial intelligence (AI) company Innovaccer surveyed 116 provider and value-based care leaders in August for "The Technology Strategy Survey."

Only 30% believe ACCESS payments will fund that strategy, according to Innovaccer's summary of the report, which requires registration to download.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center launched ACCESS on July 5 as a voluntary 10-year model in traditional Medicare. It pays Medicare-enrolled organizations a recurring fee to manage conditions including high blood pressure, diabetes, chronic musculoskeletal pain and depression using tools like telehealth, wearable devices and apps.

Full payment is tied to whether patients' health measurably improves. More than 160 organizations are participating, most of which have not previously served Medicare beneficiaries, according to CMS.

NAACOS represents more than 500 accountable care organizations (ACOs) and other value-based care entities and is among the groups CMS lists as supporting the model.

Innovaccer, the survey's other sponsor, promotes an ACCESS offering on its website and acquired virtual specialty care company Story Health in 2025. Three Story Health Partners entities appear on CMS' list of accepted ACCESS participants.

Where the money comes from

Ninety-three percent of respondents have an AI strategy for care delivery, and 73% have already invested in AI-enabled care management or virtual care.

For the next 12 months, 56% are prioritizing AI-driven risk stratification, 52% electronic health record and data interoperability and 46% patient engagement and outreach.

Forty-five percent named funding as the single biggest barrier to adopting technology-enabled care, and 80% said those costs come out of their operating budgets.

Respondents also cited a need for better data and interoperability (51%), clearer regulatory guidance from CMS (45%) and stronger financial protections (40%).

"What this research shows is that proof is the currency that closes the gap between strategic conviction and financial commitment," Abhinav Shashank, co-founder and chief executive officer of Innovaccer, said in the announcement.

He described Innovaccer and Story Health as built to meet the standard leaders are waiting for.

Under ACCESS, primary care physicians and other referring clinicians who review an organization's care update and act on it, such as adjusting a medication or updating a problem list, can bill a co-management payment of $30, subject to geographic adjustment and sequestration.

They can bill it up to three times per patient, per track, during a 12-month care period, plus a one-time $10 add-on per patient and track for helping a patient get set up. Patients owe no cost-sharing, and clinicians don't need to enroll in the model to bill.

The organizations delivering the care receive annual payments of $180 to $420 per patient for an initial care period, depending on the condition track.

Half of Medicare's share is withheld until the 12-month care period ends. Through 2027, organizations can earn full payment if at least half of their patients meet all of their clinical targets, according to CMS.

In a February analysis, NAACOS called those rates "lower-than-anticipated" and wrote that managing complex chronic conditions often takes more intensive care than the model can finance.

The association urged ACCESS organizations to partner with ACOs and primary care practices rather than duplicate their care management work.

"The ACCESS model is a clear signal reinforcing these investments," Emily D. Brower, MBA, president and chief executive officer of NAACOS, said in the announcement.

Many leaders are optimistic the model will bring needed regulatory guidance, better data sharing and a stronger evidence base and payment structure for technology-enabled chronic care, she said.

Waiting on evidence

"This is a bit of a mystery because you would hope that the ACOs would be sort of the first place where you would see some of the tech adoption," Caroline Pearson, executive director of the Peterson Health Technology Institute, said in a September interview with Medical Economics.

In fee-for-service medicine, health systems can use technology to raise revenue, Pearson said. "In an ACO or other risk-based payment model ... you have to be confident that the technology is improving the clinical outcomes and reducing total cost of care," she said.

"There's not a pure revenue play, and generally, I think the ACOs have not found that the evidence that is available to them about the performance of these technologies is compelling enough to drive further adoption," Pearson said.

Her institute's recent report on paying for clinical AI argues that applying today's payment models to AI would inflate costs under fee-for-service while doing too little to encourage adoption under pay-for-performance and capitated arrangements.

Under ACCESS, "technology companies can sign up to be paid directly by Medicare for services provided for chronic care management if they deliver clinical outcomes as set forth by the program," Pearson said.

Patients don't need a referral to enroll with an ACCESS organization, though each organization must designate a physician medical director, according to CMS.

Who's enrolled

Twenty-one percent of respondents said they formally monitor claims data to see which of their patients are enrolled in ACCESS.

Seventy-five percent reported no change, or no plans yet to change, their approach to technology partnerships.

ACCESS organizations must, with the patient's consent, send care updates to the patient's primary care physician and referring clinicians when care begins, if it escalates and when it ends.

By July 2027, they must also connect to a health information exchange or CMS-aligned network so physicians can pull patient data such as blood pressure and hemoglobin A1c readings into their existing workflows, according to CMS.

NAACOS asked CMS in February to add an ACCESS enrollment flag to the claim and claim line feed files ACOs receive, which it said would give providers visibility into the model.

"I think that patients need more support, and primary care specialists need more partners," Jennifer Brull, M.D., FAAFP, board chair of the American Academy of Family Physicians, said at a Sept. 15 launch event hosted by the U.S. Department of Health and Human Services.

"I think at the same time we have to be careful that more support does not equal more care fragmentation," she said.

CMS says ACCESS complements ACOs by giving them new care options for patients with chronic conditions.

The agency expects ACCESS payments to have no effect on benchmark or performance-year calculations for the Medicare Shared Savings Program and ACO REACH in 2026 and 2027. Starting in 2028, spending on those payments will count, according to CMS.

ACCESS organizations also can't bill fee-for-service Medicare for other services to patients aligned with them during an active care period, a rule NAACOS has asked CMS to suspend for ACOs that want to join the model.

Early implementation

"We haven't heard as much about this in terms of the implementation," Madison Hynes, M.P.P., an associate director of government affairs at the Medical Group Management Association (MGMA), said of ACCESS during the association's Washington update Sept. 27 at the MGMA Annual Conference 2026 in San Antonio.

Hynes said the model's public directory may have launched a few months late and asked physicians who refer patients to ACCESS organizations to share their experience with MGMA.

CMS had told clinicians the directory would launch in July. It went live Sept. 15 with options from nearly 40 organizations, CMS Chief Technology and AI Officer Jacob Schiff said at the launch event.

What comes next

On April 1, 2027, ACCESS will add tracks for heart failure, chronic obstructive pulmonary disease, substance use disorder and tobacco cessation, according to CMS.

Beginning in winter 2028, the agency plans to publish risk-adjusted outcomes for each participating organization in its directory and on Data.CMS.gov so referring physicians can compare partners on results.