Modelo CMS ACCESS: Prestadores preparam-se para cuidados de saúde baseados em tecnologia e valor
On December 1, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions), a voluntary, 10-year initiative aimed at improving care for Medicare beneficiaries with chronic conditions. This model reflects CMS’s continued commitment to value-based care and introduces new opportunities — and challenges — for health care organizations and supporting technology innovators.
Overview of the ACCESS Model
The ACCESS Model will test Outcome-Aligned Payments, a new payment option that will reward health outcomes rather than required activities. Participants will receive predictable payments for managing qualifying conditions and earn the full amount only when patients meet measurable health goals, such as lower blood pressure or reduced pain. Care can be in person, virtually, or asynchronous, whatever meets patients’ needs.
The model is designed to complement traditional care by addressing gaps in chronic condition management by leveraging technology-supported care and outcome-based payment structures. Clinical outcome-based reimbursement encourages providers to use technology, clinical tools, and care approaches that best meet patient needs.
Key dates include:
- Application Opens: January 12, 2026
- Application Deadline: April 1, 2026
- Model Launch: July 1, 2026
Model participants must be Medicare Part B-enrolled organizations (excluding DMEPOS and laboratory suppliers). Organizations interested in participating should complete the ACCESS Model Interest Form and begin assessing readiness for digital health integration.
Core Features
- Outcome-Aligned Payments: Fixed installment payments tied to meeting defined clinical benchmarks.
- Technology Integration: Remote monitoring, digital health tools, and virtual care options are core components.
- Condition-Specific Tracks: Focus areas include cardiometabolic, cardio-kidney-metabolic, musculoskeletal, and behavioral health conditions. Participants must manage all conditions within a given track and support patient-centered care.
Implications for Providers
Participation will require meaningful changes across operations and clinical practices. Start by reviewing infrastructure: can your current systems handle remote monitoring and deliver accurate data reporting? Next, think through workflow integration — how will technology fit into daily routines without disrupting patient care? Finally, weigh financial risk. Outcome-based payments introduce performance risk, so organizations need a clear strategy to meet CMS benchmarks and protect revenue.
Considerações estratégicas
The ACCESS Model represents a meaningful shift to technology-enabled, patient-centered care. For providers, this is both an opportunity and a challenge. Early adopters can position themselves as leaders in digital health and chronic care innovation. Success depends on robust data analytics, patient engagement strategies, and alignment with CMS quality metrics.
Conclusão
The ACCESS Model is a gateway to accelerated digital health adoption in traditional Medicare. The door is opening to technology-enabled chronic care management.
At Foley, we are actively advising providers across the country on how to respond to this evolving legal landscape. From policy development and compliance strategy to enforcement defense, we are here to help. Please reach out to the authors, your Foley relationship partner, or to our Health Care Practice Group and Health Care & Life Sciences Sector with any questions.
