Will ACCESS move the needle on tech-enabled chronic care?

What does the ACCESS model entail?

The 10-year ACCESS model will test a new payment option to increase the use of digital health technologies for treating four chronic diseases among fee-for-service (FFS) Medicare beneficiaries: hypertension, diabetes, chronic musculoskeletal pain and depression. The model will test Outcome-Aligned Payments (OAPs), a payment option in which organizations receive recurring payments for managing chronic conditions, with the total payment being tied to measurable health outcomes. 

Each chronic condition included in the model represents a track with unique condition-specific measures and outcome targets, such as improvements in blood pressure, hemoglobin A1c, lipids, weight or patient-reported outcome measures (PROMs) of pain, mood and function.  

Participants in the new payment option must adhere to an Outcome Attainment Threshold (OAT), which represents the minimum percentage of beneficiaries who must complete 12 months in the program and meet all required outcome targets. The model will begin on July 5, 2026, and the OAT for the first year is 50%.

"We've tried over many decades now to figure out how to tie the work that clinicians do, that health systems do, for patients to the outcomes patients are actually experiencing," said Ashul Govil, M.D., co-founder and chief medical officer at digital specialty care provider Story Health, in an interview. "ACCESS is the latest innovation…[and it] takes a little bit different spin in that it requires technology to be used."

From its launch through Dec. 31, 2027, participants will receive between $180 and $360 for the initial period of the clinical track they participate in. The initial period refers to the first year of a patient's care in a given clinical track. Three of the four tracks also have a follow-on period, which refers to the continued management of beneficiaries beyond the initial period. Payments for the follow-on period range from $90 to $210.

How do digital health companies view the model?

Overall, digital health leaders view the ACCESS model as a promising pathway to expanded access to technology.

Patrick Sheehan, vice president of value-based care at remote monitoring device provider Withings Health Solutions, noted that the model aligns with consumer demand for greater self-management and home-based care options, as well as provider demand for enhanced clinical decision support. However, payment models have not progressed concurrently.

"What ACCESS is really creating is the payment environment so that the consumer who wants to self-manage and the healthcare professional who wants to use that data efficiently and effectively to titrate medications or to promote lifestyle change can do so in a way that is properly paid for," he said in an interview.

Oren Nissim, CEO of remote care provider Brook Health, agreed, adding that ACCESS is targeting chronic conditions that require a continuous care approach and easing access to technology that can effectively support that care.

"We're looking at this as a genuine approach to provide Medicare beneficiaries with direct access to digital health tools and to be able to get that to be utilized further and further because the current system requires a lot more, essentially, going through red tape," he said.

By allowing healthcare providers and patients to cut through the red tape more easily and access digital health technology, the model is primed to advance value-based care.

Govil, who is also a cardiologist at Sutter Health, noted that the model's value-based care nature will require digital health companies participating in it to shift their business strategy. They will have to focus more broadly on quality measures, rather than just the services they can bill for.

"It really forces people to think about, well, if we're shifting towards an outcomes-based model, increasing the codes that we're billing may not be enough," he said. "We really have to focus now on the real, true value of healthcare, right? Which is achieving better blood pressure, better diabetes control for patients."

Essentially, ACCESS will push digital health companies to determine the best way to support traditional providers in achieving value-based care, he added.

What are the model's gaps?

Despite their largely positive outlook, digital health leaders did point to several sticking points in the model details. For instance, though Brook Health intends to participate in the model, Nissim underscored that the reimbursement rates pose a challenge.

"It's not a lot of money at all," he said, adding that clinicians will still need to be involved in the patient's care and paid for it. Also, he noted that patients still need to be onboarded into care, which involves ancillary services like lab tests, and require various touchpoints with their care teams throughout their chronic care journey, which adds to the overall cost of care.

This view echoes that of healthcare attorney Carrie Nixon, who wrote on LinkedIn that the model rates seem "like a 'set it and forget it' method of care management that doesn't take into account the need for ANY clinician interaction."

However, Sheehan and Govil shared a more optimistic view of the lower-than-expected payment rates.

"Constraint creates innovation, right? The market needs constraints to be able to work," Sheehan said.

Further, because the model pays for outcomes rather than service volume, he believes it will align incentives among digital health stakeholders.

"ACCESS does a really good job making it so that there's less friction in terms of removing the need for contracting between health systems and technology companies and making it so that both parties can be rewarded," Sheehan said.

Govil echoed Sheehan, further noting that the model aims to create efficiencies, forcing health systems, digital health companies and third-party service providers to rethink how they partner to deliver care. All stakeholders will have to work together to achieve good outcomes within the model's financial constraints.

Still, the need to create or renegotiate partnerships could create barriers to adoption among providers.

"I don't think everyone will figure this out," Govil said. "I think there'll be a few who will think much more innovatively than they have in the past, and that will force them to new solutions we've never seen before."

In addition to slower adoption among providers, Nissim stated that the model may pose a barrier to entry for patients who would benefit from technology-enabled chronic care. The model still requires patients to interact with the health system, which may be inconvenient for the old, the chronically ill and those in rural areas.

"I think [the model] doesn't consider the way to enter into it in order to receive care," Nissim said. "That's the key thing. It does take into account what needs to happen thereafter, and thereafter is the thing that, in some ways, is easier to achieve."

Though it remains to be seen whether the model will be viable and achieve its intended goals, digital health leaders emphasized that it is just the starting point for value-based digital healthcare.

"It's not going to be perfect on day one, but it's a place where we can start to influence outcomes, do it in a meaningful way, do it in an efficient way that's also not cost-prohibitive for the system," Govil said. "And then let's build from there."

For instance, Govil expects the model to eventually expand to include additional chronic diseases beyond the currently selected ones.

Also, as healthcare providers and digital health companies come on board and the experiment begins in earnest, areas of improvement will become clearer, enabling CMS to adjust the design as needed.

"Over a period of time, it is obviously intended to be measured and developed such that it could become a genuine alternative and then potentially replace other models, but that'll take longer," Nissim said.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.