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The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced that numerous major health plans from across the nation have signed on to participate in the ACCESS pledge.
ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a model that expands access to technology-supported care for individuals on Original Medicare with obesity, diabetes, musculoskeletal pain and depression.
Plan participants who signed on include Blue Shield of California, BlueCross BlueShield of Tennessee, Devoted Health, Horizon Blue Cross Blue Shield of NJ, Blue Cross and Blue Shield of Minnesota, CVS Health, Blue Cross Blue Shield of North Dakota, Cigna, Centene, Guidewell, Arkansas Blue Cross and Blue Shield, Humana, UnitedHealthcare and CareFirst BlueCross BlueShield.
The plans, which CMS says represent 165 million Americans with Medicare Advantage, Medicaid and private insurance, are pledging to adopt an outcomes-based payment structure that aligns with the model.
"The ACCESS Model begins its 10-year performance period in July 2026; under the ACCESS Payer Pledge, payers commit to offering payment arrangements that align with core principles of the model by January 1, 2028," CMS said in a statement.
Additionally, the federal agency states that it is creating a set of optional resources for health plans, including standardized billing codes, a FHIR-based reporting infrastructure to allow plans to submit performance data aligned with the ACCESS model and reference documents, such as payment adjustment codes and sample provider agreement structures.
The resources are expected to be available later this year.
THE LARGER TREND
Dr. Mehmet Oz, the administrator of CMS, unveiled the CMS ACCESS initiative in December. In a video, Oz introduced the model as a way of paying for care that focuses on results.
The program is structured around four clinical tracks: early cardio-kidney-metabolic conditions, established cardio-kidney-metabolic diseases, musculoskeletal conditions and behavioral health conditions.
The model includes an Outcome-Aligned Payments option for organizations, which ties reimbursement to measurable improvements in health outcomes and requires organizations to deliver integrated, technology-enabled services through in-person, virtual or asynchronous modalities.
To qualify, organizations must enroll in Medicare Part B; comply with licensure, HIPAA and FDA requirements; and designate a physician clinical director to oversee clinical quality.
