Dr. Mehmet Oz, administrator for CMS
Photo: Anna Moneymaker/Getty Images
The Center for Medicare and Medicaid Services (CMS) Innovation Center has launched ACCESS, a model that expands access to technology-supported care for individuals on Original Medicare with obesity, diabetes, musculoskeletal pain and depression.
Dr. Mehmet Oz, administrator for CMS, said in a video that the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model will support two out of every three people on Medicare and will run for 10 years starting July 1, 2026.
"ACCESS introduces a way of paying for care that focuses on results. It offers clinicians a new predictable payment option, giving them the flexibility to use digital tools that help people take charge of their health," Dr. Oz said.
The program focuses on four clinical tracks: 1) early cardio-kidney-metabolic conditions (eCKM), such as hypertension, dyslipidemia, obesity and prediabetes; 2) cardio-kidney-metabolic conditions like diabetes, chronic kidney disease and atherosclerotic cardiovascular disease; 3) musculoskeletal conditions; and 4) behavioral health conditions, including depression and anxiety.
It will utilize an Outcome-Aligned Payments option for Medicare-enrolled care organizations, meaning organizations that achieve measurable health outcomes, such as lowering blood pressure for patients with hypertension, will receive payments tied to those achievements.
Care organizations will also be expected to provide integrated, technology-enabled services ranging from clinician consultations and behavioral support to diagnostics, medication management and monitoring of FDA-authorized devices. Care can be provided in person, virtually or asynchronously.
Participating organizations must enroll in Medicare Part B, meet licensure, HIPAA and FDA requirements, and appoint a physician clinical director to oversee clinical quality.
CMS will maintain a directory of all ACCESS organizations, the conditions they treat and their outcomes. It will also track and report aggregated, risk-adjusted performance metrics to help inform patients who choose to enroll.
"ACCESS will help people meet their health goals and remove barriers for clinicians who want to integrate technology into their care," Abe Sutton, director of the CMS Innovation Center, said in a video.
"It will also make it easier for primary care doctors to partner with technology-supported care providers so they can continue supporting patients with chronic conditions even when they step outside the doctor's office. For patients, that means new care options that fit into daily life and extend their care team."
THE LARGER TREND
CMS has made numerous announcements this year to expand access to healthcare technologies.
In July, Amy Gleason, strategic advisor to the U.S. Department of Health and Human Services and CMS and acting administrator of the U.S. Department of Government Efficiency, said CMS is embracing the idea of allowing patients to scan a QR code at the doctor's office and share their medical history.
Gleason said CMS is building the core infrastructure to accomplish this, which includes a national healthcare directory, modernized systems and secure data entry.
That same month, CMS released its proposed calendar year 2025 physician fee schedule, which includes recommendations on coverage of digital health tools, including digital therapeutics and telehealth services.
President Donald Trump also announced the CMS Interoperability Framework in July, a new federal Health Technology Ecosystem that aims to eliminate faxed medical records and expand app-based data sharing across the healthcare system.
The initiative, led by CMS, centers around an interoperability framework called the CMS Aligned Network, which aims to give patients and clinicians easier access to medical records.
Major health IT vendors, information exchanges, tech companies and healthcare systems participated in developing the ecosystem.
