CMS Announces New VBC Model for Advancing Chronic Care with Effective, Scalable Solutions (ACCESS)

Just when we thought telehealth was dead since the COVID-19 pandemic-era telehealth flexibilities expired on Oct. 31, 2025, and just when we though remote patient monitoring RPM was going to meet a similar fate when United Healthcare announced it will significantly limit RPM reimbursement effective Jan. 1, 2026, CMS drops a new VBC model with the potential to revive them both.

Below is a quick summary of the new ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model, and I have also placed a link in the comments for the official CMS ACCESS model information page, but I want to highlight a few of things:

1. The key difference between this model and previous value-based care models is that it is very specific about how outcomes are measured.

2. The model requires beneficiaries to opt in, which is in contrast to the ACO models, which used a provider attribution formula.

3. The model is not just for care providers, oppose to historic CMMI VBC models, which limited participation to physicians, PGs, Hospitals, PAC providers (remember BPCI model 3? 😁 ). Tech companies can participate in the ACCESS model under the guidance of Physician Medical Directors.

4. There is no mention of how much participants will be reimbursed for achieving the required outcomes, which is problematic since it's impossible to create a business case without some type of "fee schedule".

ACCESS Model Summary

• Program Goal: To test an outcome-aligned payment approach in Original Medicare (FFS) to expand access to new technology-supported care options that help people prevent and manage chronic disease.

• Payment Innovation (Outcome-Aligned Payments - OAPs): The model introduces Outcome-Aligned Payments (OAPs) — a recurring payment for managing a patient's qualifying condition, with full payment tied to achieving measurable health outcomes, such as lowering a patient's blood pressure by 10 mmHg. This shifts the focus from paying for defined activities (fee-for-service) to rewarding results.

• Focus & Scope: The voluntary model focuses on chronic conditions that affect more than two-thirds of people with Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression.

• Care Delivery: Participating ACCESS care organizations will provide integrated, technology-supported care, which may include:

  • Telehealth software for patient interaction.

  • Monitoring via wearable devices (e.g., for sleep, heart rate, blood sugar).

  • Apps for lifestyle and behavioral coaching (nutrition, exercise, smoking cessation).

  • Clinician consultations, therapy, and counseling.

  • Medication management and care coordination.

  • Use or monitoring of Food and Drug Administration (FDA)-authorized devices.

Key Dates

• Model Duration: The model will run for 10 years.

• Start Date: The first performance period begins July 1, 2026.

• Application Deadline (First Start): Applications must be submitted by April 1, 2026, to be considered for the July 1, 2026, start.

• Second Start Date: Applications received after April 1, 2026, will be considered for a January 1, 2027 start.

Program Participation Criteria

• Required Participant Type: Organizations must be Medicare Part B–enrolled organizations.

  • Exclusions: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and laboratory suppliers are excluded.

  • Organizations not currently enrolled in Medicare Part B must enroll to participate.

• Required Personnel: Participating organizations must designate a Medicare-enrolled Medical Director (or physician Clinical Director) to oversee care quality and compliance.

• Patient Enrollment: Patient participation is voluntary. Patients voluntarily sign up directly with participating ACCESS care organizations, either on their own or upon referral from their provider.

• Compliance: Participants must comply with all applicable federal and state regulations, including licensure, HIPAA, and FDA requirements.