Hotly anticipated performance targets and payment amounts for the Centers for Medicare & Medicaid Services (CMS) Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model have been made publicly available, prompting a fresh round of scrutiny among organizations considering participation.
Federal officials have labeled ACCESS an “outcome-aligned payment approach in Original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage chronic disease.” The Model focuses on conditions affecting more than two-thirds of people with Medicare – including high blood pressure, diabetes, chronic musculoskeletal pain, and depression – and is expected to run for 10 years, beginning July 5, 2026.
The Model was unveiled in December 2025, with applications being accepted starting in January 2026. Applications for participation in the first performance period must be submitted to the CMS Participant Portal by April 1, with subsequent applications to be considered for a Jan. 1, 2027 start.
The newly unveiled performance targets and payment amounts are laid out in a 21-page primer available online here: https://www.cms.gov/priorities/innovation/files/access-payments-amts-perf-targets.pdf
Rapid Reaction
“My phone has been ringing nonstop this morning, and text threads are firing about the program since the update,” Second Opinion Media CEO Christina Farr wrote in a post published late last week. “Many companies in digital health are still digesting the news to assess whether it’s a fit, and I’ve heard from some companies that the expectation in the industry was that the rates would be low, as the government has been very clear that we need to take steps to bring down costs. Healthcare finally needs a deflationary moment.”
Still, Farr noted, payments need to be high enough to actually encourage participation in the program.
“And these rates are lower than some of the rates that operators and policy experts I’ve been speaking to expected,” she added.
Other takeaways Farr noted from feedback included the notion that ACCESS will require marketing to Medicare patients, demanding a step outside the established fiscal comfort zones of some organizations. The published rates also account for the patient paying their cost-share, she noted – and if companies want to waive it, the total amount they will be paid is 20 percent lower than the published rates.
“This subset of the population is so expensive to reach, given competition for eyeballs with Medicare Advantage. And health systems have also historically been a difficult channel to market through. Will there be enough of an incentive here for hospitals to promote the program to their patients?” Farr asked. “In theory, the hospital could bill separately for educating the patient about the program, and then for co-managing them with a digital health partner. But is the juice worth the squeeze without other ROI for the hospital?”
Farr predicted that the most likely companies that will get involved initially are fully autonomous and heavy on AI/technology, rather than heavy service companies with “humans in the loop.”
Still, Mobi Health News noted in an article published last week that some plan participants have shown no hesitation in signing up – a list they said now includes 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 Mobi noted 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.
Cigna was an outlier among its peers in issuing a public statement several days ago outlining its positioning as an early – and eager – adopter.
“The ACCESS Model Aligned Payer Pledge signed by The Cigna Group and others complements the ACCESS model by committing them to implement an outcome-aligned payment option for technology-enabled chronic care, even if the payment option is not for Traditional Medicare,” the statement read. “According to the Centers for Disease Control and Prevention (CDC), 60% of U.S. adults have at least one chronic disease today while 90% of the nation’s annual health spending is linked to chronic physical and mental health conditions. CMMI’s (The Center for Medicare & Medicaid Innovation’s) stated goals for the ACCESS model as well as the aligned payer pledge are to give patients more options to help them meet their health goals, give providers new partners to help them co-manage their patients’ health, and provide a way to pay care organizations developing technology-supported services in Traditional Medicare in the model and in other markets.”
Cigna added that a payment approach will be considered “ACCESS-aligned” if it adopts the core ACCESS model principles of:
- Predictable, recurring payments;
- Accountability for clinical improvement or control;
- Flexibility in care delivery that facilitates technology-enabled care; and
- Coordination with primary care and referring clinicians.
Entrenched Trepidation
Not all industry feedback has been quite so rosy.
“For rural systems … the shift presents unique challenges. Darrell Bodnar, CIO of North Country Health (Whitefield, N.H.), supports the ACCESS model in principle – but said previous CMS initiatives show that good intentions aren’t enough to guarantee success,” Naomi Diaz wrote in a December 2025 Becker’s Hospital Review article on the topic.
“Conceptually, the ACCESS model aligns with where healthcare needs to go, particularly for chronic care in rural systems where access, workforce constraints and geography are ongoing challenges,” Bodnar told Becker’s. “The focus on outcomes-based payments and technology-supported care fits with investments many organizations, including ours, are already considering or piloting. That said, I approach ACCESS with cautious optimism.”
Bodnar specifically cited the Medicare Shared Savings Program (MSSP) and Accountable Care Organizations (ACOs), which “often fell short due to a lack of implementation support.” Another example: KFF Health News noted in an article late last week that a different 10-year CMS program, Making Care Primary, ended more than nine years prematurely just last March.
“Nearly 700 practices in eight states (had) enrolled in Making Care Primary,” the report read. “North Carolina had 23 clinics and centers in the program, the most of any state, followed by Washington, New Mexico, and New York. Doctors who had signed up for it said they were stunned.”
“Experience with models like MSSP and ACOs has shown us that success depends less on the intent of the program and more on whether organizations are given enough operational and financial runway to make meaningful changes,” Bodnar told Becker’s, adding that the “cost of tools, integration, care coordination and data reporting can be steep – particularly for smaller systems already operating on tight margins.”
“For ACCESS to truly work, there needs to be funding that helps organizations stand up the model and subsidize its early phases while care models, workflows and outcomes stabilize,” he added. “Without that transitional funding and flexibility, there’s a risk that participation becomes difficult to sustain or limits adoption to only the largest organizations.”
CMS certainly seemed undaunted when agency Administrator Dr. Mehmet Oz kicked things off with a YouTube video in early December.
“Technology can transform healthcare from something that happens in a doctor’s office to something that’s always within reach, empowering people to prevent disease and manage chronic conditions,” he said.
“Patients will have more options to help them meet their health goals, providers will gain new partners to help them co-manage their patients’ health, and Original Medicare will have a way to pay care organizations developing technology-supported services,” CMS promised in a press announcement.
Federal officials have emphasized that participating in ACCESS won’t change Medicare benefits, coverage, or rights for individual beneficiaries – and patients can continue to see any Medicare provider. They also noted that all ACCESS participating organizations must continue to comply with all applicable federal and state regulations – including licensure requirements and Health Insurance Portability and Accountability Act (HIPAA) and Food and Drug Administration (FDA) requirements.
“CMS will monitor performance and may terminate organizations who fail to meet quality, safety, or outcome standards,” the announcement added. “To promote transparency, CMS will publish risk-adjusted outcomes in a public directory.”
Regardless of evaluation in the abstract, the proof will lie in actual program results. Will reimbursement for outcomes, rather than activities, with technology playing a pivotal role, actually create a better healthcare environment for providers, patients, and payers alike?
We’re about to find out.
References
Coming in Hot: How Digital Health is Reacting as CMMI Releases Payments, Targets & More for the ACCESS Model (published February 13, 2026): https://secondopinion.media/p/coming-in-hot-industry-reactions-to-the-payments-from-the-cms-access-model
Major Health Plans Join CMS ACCESS Outcomes-Based Care Model (published February 13, 2026): https://secondopinion.media/p/coming-in-hot-industry-reactions-to-the-payments-from-the-cms-access-model
The Cigna Group Works to Strengthen Chronic Care Management by Signing CMS Innovation Center’s ACCESS Model Aligned Payer Pledge (published February 12, 2026): https://secondopinion.media/p/coming-in-hot-industry-reactions-to-the-payments-from-the-cms-access-model
CIOs See Promise, Pitfalls in CMS’ ACCESS Care Model (published December 12, 2025): https://www.beckershospitalreview.com/healthcare-information-technology/innovation/cios-see-promise-pitfalls-in-cms-access-care-model/
Clinics Sour on CMS After Agency Scraps 10-Year Primary Care Program Only Months In (published February 13, 2026): https://kffhealthnews.org/news/article/cms-mcp-lead-primary-care-model-canceled-rural-health-north-carolina/
https://www.cms.gov/priorities/innovation/innovation-models/access
