The Centers for Medicare & Medicaid Services (CMS) has just made one of the clearest moves yet toward permanent, outcomes based payment for chronic disease in Original Medicare. The new ACCESS Model, which stands for Advancing Chronic Care with Effective, Scalable Solutions, is built around technology supported care and measurable clinical outcomes, not units of service.
At Pear, we have been working at the intersection of primary care, virtual care, and value based payment for years. ACCESS is exactly the kind of model we have been anticipating. It rewards the things modern care teams do best when they are supported by the right technology and workflows.
In this post, we will break down what ACCESS actually is, how it works, and how different stakeholders should be thinking about it now.
What is the ACCESS Model?
The ACCESS Model is a 10 year national test in Original Medicare that introduces a new payment approach called Outcome Aligned Payments (OAPs). The goal is to expand access to technology supported care for people with chronic conditions, and to pay organizations based on whether they improve or control those conditions.
Instead of paying for individual visits, devices, or codes, CMS will pay participating organizations a recurring amount to manage specific qualifying chronic conditions. Full payment depends on achieving measurable health outcomes, such as improvement or control of blood pressure for hypertension, using each patient's baseline as the reference point.
ACCESS is not another short term pilot. It is structured as long term infrastructure for chronic disease management in Original Medicare.
Timeline and key dates
Several timing details are now clear from the CMS model page and technical FAQ:
- Model start and duration. ACCESS begins July 1, 2026 and will operate for 10 years, through June 30, 2036.
- First cohort deadline. To be considered for the first performance period beginning July 1, 2026, applications must be submitted by April 1, 2026. Applications received after that date will be considered for a January 1, 2027 start.
- Rolling entry. CMS will accept applications on a rolling basis beginning in January 2026 and continuing through 2033, with each cohort starting on defined dates during the model.
For organizations that want to be early, the practical takeaway is simple: December 2025 and early 2026 are the planning window. The first real dollars start flowing in mid 2026. ACCESS Model - Interest Form
Which conditions does ACCESS focus on?
ACCESS organizes chronic care into four clinical tracks that together cover conditions affecting more than two thirds of Medicare patients
Early Cardio Kidney Metabolic (eCKM). This track is for people with elevated risk factors and early cardiometabolic disease. It includes hypertension, dyslipidemia, obesity or overweight with central obesity, and prediabetes. The emphasis is on early intervention and prevention, not waiting for organ damage or major events.
Cardio Kidney Metabolic (CKM). CKM covers diabetes, stage 3a and 3b chronic kidney disease, and atherosclerotic cardiovascular disease, including heart disease. Here the focus shifts from risk factor control to slowing disease progression and avoiding high cost complications such as heart failure, stroke, and dialysis.
Musculoskeletal (MSK). The MSK track is for chronic musculoskeletal pain. It is built around improving pain, function, and daily activity using validated patient reported measures rather than relying only on procedures, opioids, or imaging.
Behavioral Health (BH). The BH track targets depression and anxiety. It uses tools such as PHQ 9 and GAD 7 for symptom measurement, along with WHODAS 2.0 for function, and is explicitly designed to make scalable, tech enabled behavioral health care part of chronic care rather than a separate silo.
Each track has its own specific outcome measures and targets, but they all share the same basic logic: control or minimum clinically meaningful improvement, relative to baseline, determines how much of the OAP payment an organization actually keeps.
How Outcome Aligned Payments work
ACCESS replaces visit based payment for these conditions with Outcome Aligned Payments. Conceptually, OAPs function like a recurring condition specific payment that is reconciled against results.
In practice, organizations:
- Confirm eligibility and establish a baseline. For each patient and track, the organization confirms that the patient has a qualifying condition and documents baseline measures. For example, blood pressure for hypertension, a combination of blood pressure, lipids, weight, and hemoglobin A1c in eCKM and CKM, or PHQ 9 and GAD 7 in behavioral health.
- Deliver intensive, technology supported care. During the active care period, the organization provides whatever mix of virtual visits, in person visits, coaching, device supported monitoring, medication management, and lifestyle support is clinically appropriate, as long as it meets CMS guardrails and documentation requirements. OAPs are paid on a recurring basis during this phase.
- Reconcile payment based on outcomes. Payment is determined by the overall share of patients who achieve either guideline informed control or a minimum improvement threshold for the track. CMS also sets minimum performance thresholds that increase over time, so expectations get tighter the longer an organization is in the model.
For most tracks, there is an optional continuation period after the initial phase. During continuation, organizations receive OAPs at a reduced rate that reflects lower ongoing resource needs once care is established. The MSK track is an exception. There is no continuation period because the goal is to resolve chronic pain and transition people back to usual care, not to manage pain indefinitely as a chronic dependency.
ACCESS also uses random assignment for a small share of beneficiaries in each track so CMS can rigorously evaluate outcomes and costs. Those in the control group keep all usual Medicare benefits and can receive standard care from their existing clinicians.
How ACCESS treats primary care and co-management
CMS is explicit that ACCESS is meant to complement, not replace, primary care. Patients remain in Original Medicare, and their usual primary care practitioners stay at the center of their overall care.
To make collaboration real and billable, CMS has created a new ACCESS Co-Management Payment that primary care and other referring clinicians can use when they review updates from an ACCESS organization and document related care coordination.
Key details from the technical FAQ:
- Clinicians who co-manage ACCESS beneficiaries with a participating organization may bill a new co-management service for documented review of ACCESS updates and associated care coordination activities, such as medication changes or updates to the problem list.
- The service will be paid at approximately 30 dollars per co-management encounter, subject to geographic and standard Medicare adjustments.
- Clinicians who help a beneficiary with onboarding and initial setup may bill the same code with a CMS specified modifier the first time for an additional approximately 10 dollars, again subject to standard adjustments.
- The co-management payment can be billed once every four months per beneficiary per track, up to about 100 dollars per year, and there is no Part B cost sharing for patients.
For primary care groups and other referring clinicians that are already in ACOs, bundled payments, or Medicare Advantage arrangements, this creates a new revenue stream for the work of coordinating with technology enabled care teams, which until now has often gone unpaid.
What counts as “technology supported care” in ACCESS
CMS is deliberately broad in its definition of technology supported care. The model page calls out a range of tools that ACCESS organizations are expected to deploy in a clinically guided way. These include telehealth software, wearable devices, apps for behavior change and coaching, remote monitoring solutions, and other digital tools that extend care beyond the clinic.
At the same time, there are important guardrails:
- Participants must be enrolled in Medicare Part B as providers or suppliers, comply with applicable state licensure rules, and meet HIPAA and FDA requirements, or fall under FDA enforcement discretion where appropriate.
- Each participating organization must designate a physician Clinical Director responsible for clinical quality and compliance.
- Participants must share electronic care plans and updates at key moments such as initiation, completion, and clinical milestones, and they must integrate with a Health Information Exchange or similar trusted network so referring clinicians can access updates.
ACCESS will also include an ACCESS Tools Directory, a CMS hosted resource where vendors can list optional software and hardware tools, ranging from interoperability solutions to connected devices and compliance support. Participation in that directory is voluntary and non endorsing, but it signals that CMS expects a healthy ecosystem of technology partners around the model.
Who can participate in ACCESS?
There are two related questions here: who can apply to participate in the model, and who should engage with ACCESS now, even if they are not a direct participant.
Eligibility to be an ACCESS participant
According to the technical FAQ, organizations that are enrolled in Medicare Part B as providers or suppliers are eligible to participate, with two key carve outs: durable medical equipment suppliers and laboratory suppliers are not eligible. Each organization must have an active TIN, comply with HIPAA, FDA, and state requirements, and designate a physician Clinical Director.
That means primary care groups, specialty groups, virtual first medical practices, and many types of tech enabled clinical organizations can be direct ACCESS participants if they meet these conditions.
Who should fill out the ACCESS interest form
CMS has also published an ACCESS Model Interest Form that lets a wide set of stakeholders raise their hands early. The form lists several organization types, including: potential model participant, provider who is not applying as a model participant, clinical or patient society, payer or health plan, software or hardware vendor, potential patient or caregiver, and other.
If you fall into any of those categories, you can use the interest form to receive updates when the Request for Applications is posted and when additional resources, such as the Tools Directory, become available.
What ACCESS means for different stakeholders
Because ACCESS is a payment model, not a technology program, the strategic implications are different for each stakeholder group.
Primary care and multispecialty groups
For primary care and multispecialty practices that already live in ACOs, MA risk, or other value based arrangements, ACCESS can function as a chronic care “extension” of the practice.
You can:
- Decide whether to build your own ACCESS program within your medical group or partner with an external ACCESS organization.
- Use the Co-Management Payment to make collaboration financially real rather than unpaid inbox work.
- Improve your own total cost of care by routing the right patients into high performing, technology supported programs for eCKM, CKM, MSK, and BH.
The operational work here is redesign. Practices need clear workflows for identification and referral, for review and documentation of ACCESS updates, and for shared medication and care planning.
Tech enabled chronic care companies
For virtual and hybrid chronic care companies, ACCESS is an on ramp into financially sustainable Medicare fee for service business.
If you are a software powered clinical organization that can enroll as a Part B provider or supplier, ACCESS allows you to:
- Become an ACCESS participant for one or more tracks and contract directly with Medicare.
- Use OAPs to fund intensive, high touch, data driven programs that would not fit in traditional fee for service.
- Integrate with PCPs and specialists through the required data sharing infrastructure and co-management relationships.
If you are a software or hardware vendor without a clinical entity, the Tools Directory and interest form are the obvious entry points. ACCESS participants will be looking for interoperable, compliant, scalable tools to deliver care and measure outcomes.
Payers and health plans
While ACCESS is limited to Original Medicare, the FAQ makes it clear that CMS expects payers to align with ACCESS like models. CMS plans to share reference agreements, source code, and technical documentation so payers can create similar outcome aligned contracts in their own lines of business, including Medicare Advantage and Medicaid managed care.
Payers should be using the ACCESS framework as a blueprint for their own chronic care payment reforms. It offers a ready made structure for contracting around outcomes, not utilization.
Patients, caregivers, and societies
For patient societies, clinical societies, and caregivers, ACCESS is a chance to shape how technology supported chronic care is delivered to people with Medicare.
These groups can:
- Use the interest form to stay informed.
- Educate their communities about enrollment options once participants are announced.
- Advocate for high quality, equitable ACCESS programs that respect patient preferences and address barriers such as digital literacy and connectivity.
How to get ready now
Even though the first performance period starts in 2026, the organizations that will thrive under ACCESS are already doing work in three areas.
First, know your population. Map your current Medicare panel against the four ACCESS tracks. Estimate how many patients meet eCKM, CKM, MSK, and BH criteria today, what your current control and improvement rates look like, and where you have the biggest gaps. Pear is happy to help with this for free between December 1, 2025 and January 31, 2026.
Second, evaluate your technology and data stack. Do you already use remote monitoring, connected devices, or condition specific apps in a structured way, or are they ad hoc? Can you integrate with an HIE or equivalent network today? How easily can you collect, store, and report the specific measures CMS will require for each track?
Third, decide where you want to sit in the ecosystem. Do you want to run a full ACCESS program on your own TIN, or do you want to be a referring and co-managing practice that partners with external ACCESS participants? If you are a vendor, do you want to power participants via the Tools Directory, or build clinical capacity and participate directly?
The answers will differ by organization, but the work starts now.
How Pear fits into ACCESS
At Pear, our work in value based care has always been centered on a few simple ideas:
- Outcomes first. Start from the clinical change we need to see and design care models, workflows, and staffing around that.
- Technology as leverage. Use tools that actually reduce avoidable utilization and improve patient reported outcomes, rather than just adding more data streams.
- Real integration with primary care. Build models where PCPs stay in the loop, with clear accountability and bidirectional data, not just faxed summaries.
ACCESS takes those ideas and embeds them into Medicare payment policy.
We are already helping teams translate the model into practical playbooks: how to stand up an eCKM or BH program that fits into existing clinic operations, how to structure co-management workflows with primary care, and how to align staffing and analytics with OAP risk.
If you are considering applying as an ACCESS participant, planning to be a co-managing primary care group, or building technology that could support these programs, we would love to talk about how to get you ready for July 2026 and beyond. And if you are a healthcare practice that wants a free audit of your medicare panel for free, contact us at access@pearcalls.com before January 31, 2026