The rules have changed. On July 5, 2026, Medicare began paying outside organizations to manage your highest-risk patients between their appointments with you. Those organizations did not need your referral. They did not need your approval. And once your patient attests to one of them, CMS will not allow them to switch programs for the life of the model.
That is not a prediction. It already happened yesterday.
The question is not whether your Medicare patients will have a new chronic care team. They do. The question is whether that team works with you or around you.
What the ACCESS program actually is
CMS ACCESS, Advancing Chronic Care with Effective, Scalable Solutions, is a 10-year voluntary CMMI program that launched July 5, 2026. It pays enrolled organizations, called ACCESS participants, to manage Medicare fee-for-service beneficiaries with qualifying chronic conditions continuously between visits.
The qualifying conditions are cardiovascular disease, chronic kidney disease, type 2 diabetes, and related cardiometabolic conditions, organized into two live tracks: Early CKM and Advanced CKM.
Payments are outcome-aligned. ACCESS participants receive recurring payments only if enrolled patients meet measurable clinical targets: blood pressure controlled, HbA1c reduced, and kidney function stabilized. If the numbers do not move, full payment is not released. The payment structure, between $15 and $35 per patient per month and declining after Year 1, makes manual, protocol-driven care financially unsustainable at scale. CMS designed the economics to require technology-enabled, adaptive care delivery.
What this means for primary care physicians
Your patient with stage 3 CKD and uncontrolled hypertension qualifies for ACCESS enrollment. They do not need to tell you they are signing up. They attest directly to the ACCESS participant of their choice.
Once enrolled, that participant manages their medications, monitors their biometrics, delivers health coaching, and coordinates specialist referrals, all between the visits they still have with you. Depending on who that participant is, you may receive detailed clinical updates in real time through your EHR. Or you may receive nothing at all until something goes wrong.
The co-management opportunity is real. CMS pays referring physicians approximately $100 per patient per year for documented review and care coordination activity. No outcome risk. No change to your FFS billing. But that revenue only flows if your practice has a structured relationship with an ACCESS participant that keeps you in the loop.
Without that relationship, your patients are being managed by someone you did not choose, and you are earning nothing for the clinical relationship you spent years building.
What this means for health systems and ACO leaders
The implications run deeper than co-management revenue.
ACCESS spend is excluded from ACO benchmark and performance year calculations for 2026 and 2027, which means it will not erode your shared savings performance in the near term. But your attributed population is the same population ACCESS participants are now actively enrolling. If those participants are not connected to your care infrastructure, you are losing visibility into your highest-cost patients at the moment their conditions are being actively managed.
Referral steerage is the second issue. An ACCESS participant with no obligation to route specialist referrals back into your network will not. Over a 10-year program, that is a material volume question, not a minor inconvenience.
The health systems best positioned for ACCESS are those that have already chosen a participant partner whose model keeps clinical decisions, referrals, and patient relationships flowing back through their own providers. That decision is worth making now, not later.
What happens to the patients in the middle
It is worth being direct: the patients who will benefit most from ACCESS are the ones who currently fall through the gaps. A Medicare patient managing heart failure, type 2 diabetes, and early CKD today typically has no organized clinical support between appointments. Their readings drift. Their medications stop working as well as they did. Nothing in traditional fee-for-service triggers a response until they show up in the emergency department.
ACCESS was designed to pay for what happens in that space. The model is right. The execution depends entirely on which participants are doing the managing, and whether those participants are built to deliver continuous, adaptive care or simply enroll patients and check boxes.
A patient who enrolls with a consumer wellness app will receive a different level of care than a patient enrolled with a clinical program that monitors biometrics in real time, adjusts medication protocols, and routes escalations to a licensed clinician before a deterioration event compounds. Both count as ACCESS participation. CMS leaves the quality distinction to the market.
That is why the choice of partner matters as much as the decision to participate.
Three decisions every practice and health system should make now
First: Identify your eligible population now. Medicare patients with qualifying CKD, cardiovascular, and cardiometabolic conditions in your panel are already being approached by ACCESS participants. Know how many you have and where they are before someone else does.
Second: Choose your ACCESS partner before your patients choose for you. The co-management revenue only flows through a structured participant partnership. A participant that keeps clinical updates bidirectional, routes referrals in-network, and maintains your visibility into every care decision is materially different from one that does not. Innovaccer operates through Story Health Partners, its CMS-accepted physician entity, and absorbs all outcome risk so your practice carries none. Every clinical update flows back to your providers in real time through your existing EHR.
Third: Understand the 10-year implication. This is not a pilot. ACCESS runs through 2036. The attribution, the referral patterns, and the clinical relationships that form in the first year of this program will compound over a decade. The organizations that engage early will build infrastructure, revenue, and patient relationships. The ones that wait will spend the next 10 years working around a care model that is already running without them.
The bottom line
Medicare chronic care management in 2026 is not the same program it was in 2025. ACCESS changes who delivers it, how it is paid for, and who has visibility into what happens between visits. The program launched yesterday. It is running now.
The patients who need the most coordinated care are the ones this model is reaching first. The question for every physician, CMO, and ACO leader is whether the team managing those patients is connected to you or operating in parallel.
That is not a decision that gets easier the longer it waits.
Watch the on-demand webinar:
Preparing for CMS ACCESS: Readiness, Timing, and Tradeoffs — hear from Innovaccer's policy and government affairs leads on how ACOs and health systems are evaluating readiness, where ACCESS fits alongside MSSP, and what longitudinal accountability means in practice. 64 minutes, available now.