The CMS ACCESS Model, launching July 5, 2026, is the agency's clearest commitment yet to changing the way chronic disease management is delivered at scale. The vast majority of Medicare beneficiaries live with a chronic medical condition, or are managing multiple, and do not have the necessary tools to consistently stay on top of their health goals. . Meanwhile, Medicare costs from kidney disease, heart failure, and uncontrolled diabetes are driving federal spending higher, particularly for those patients not aligned to an ACO or other CMMI models.
CMS ran the math and concluded that most physician practices cannot deliver continuous between-visit care to the full population that needs it, so it extended the care team to a new part of the market. This now includes consumer tech companies, digital health platforms, and wellness startups, many of which will be marketing to patients directly. Similar to when urgent care centers came on the scene in the 1970s, the question is not whether the health system wants to sign up; it’s how the health system will respond when these new care options are everywhere. Networks should be deciding their partnership strategies now.
The Problem the CMS ACCESS Model Was Designed to Solve
For a patient managing a chronic condition, the time between appointments is not empty. It is where things shift: a reading that drifts over three months, a medication that stops working, a stressor that disrupts every health behavior at once. None of that, under traditional fee-for-service, triggers any organized clinical response. The patient manages it on their own until the next appointment or the ED visit that replaces it.
This problem is not a new one for CMS; they have introduced remote patient monitoring codes and chronic condition management codes, but only a small fraction of practices use them, and patients have little agency in the process: enter ACCESS.
The CMS ACCESS Model pays for the care that helps fill the gap, with outcome-aligned payment contingent on whether patients actually meet measurable clinical targets: blood pressure controlled, kidney function stabilized, HbA1c reduced. Not whether a call happened or the patient came into the clinic. True alignment of goals.
What a Patient Actually Goes Through After Enrollment
Take a patient with stage 3 kidney disease and hypertension, recently referred into the program. Within their first week, they are paired with a care coach who completes program orientation, reconciles their medications, and gets remote monitoring devices in their hands for daily blood pressure and weight readings. The device is already configured for the patient and can start reading and submitting biometrics immediately.
The patient now has a clinical team at their fingertips, actively watching their readings, adjusting medications per evidence-based protocols, and delivering coaching on diet, exercise, and medication adherence between every visit. If readings fall outside the range mid-week, a nurse can escalate care, request labs, and alert the primary care physician. If a nephrology referral is needed, the nurse can again alert the PCP to request a referral for an in-network specialist.
This is the continuous chronic care management loop under ACCESS: monitoring, coaching, labs, pharmacy management, specialist coordination, and PCP review, all connected and visible to the referring provider at every step.
The major shift from CMS in this model is in the introduction of autonomous health coaching at scale. Some patients will need help with nutrition and exercise planning, while others will need more involvement from clinicians and specialists. The flexibility and intelligence of this care model is at the core of what drives success for ACCESS participants. Each patient will receive the level of intervention that they need, in the way that is most likely to keep them engaged in their own care plan.
What the PCP Sees, and What They Earn
The referring provider is not removed from this picture. They stay at the center of it.
Every clinical decision flows back through a structured ACCESS Care Update delivered to the provider's EHR inbox. This includes three types of updates: a care initiation update at enrollment, a clinical escalation alert for any deterioration event, and a final summary after the care period closes. The provider reviews the updates, documents the activity, and signs a note to close the loop for the patient co-management. The review typically takes 2 to 5 minutes.
This part of the process is funded by CMS: approximately $30 per co-management service, billable up to three times per 12-month care period, plus a one-time $10 initial visit modifier per patient. No prior authorization. No beneficiary cost-sharing. No outcome risk attached.
The referring provider knows what is happening with their patient at every stage, and is compensated for maintaining that oversight. The shared clinical record and bidirectional PCP communication are not program features; they are the architecture that keeps the practice in control of the patient relationship while the between-visit care runs continuously. Practices continue billing Medicare as they do today, with these new codes not counting toward ACO spend, and now they have a new partner in chronic condition management,
About CMS ACCESS
The CMS ACCESS Model is a 10-year program launching July 5, 2026, with more than 150 participating organizations across the country. Participants are paid for outcomes, not activity, meaning co-management fees are contingent on patients meeting measurable clinical targets. Participants cannot bill fee-for-service for the services covered under the model. The program is open to all Medicare fee-for-service beneficiaries managing chronic conditions, and beneficiaries self-attest to their ACCESS provider of choice. A referral from a physician or health system is not required for a beneficiary to enroll.
Story Health by Innovaccer is the ACCESS participant, delivering between-visit care across the eCKM and CKM tracks through virtual care teams and Adaptive Program Intelligence™.
To learn more, visit innovaccer.com/cms-access.