{"id":4613,"date":"2026-05-16T11:35:30","date_gmt":"2026-05-16T11:35:30","guid":{"rendered":"https:\/\/www.insuracarelife.com\/blog\/access-model-technology-as-key-to-managing-chronic-conditions-nelson-mullins-riley-scarborough-llp\/"},"modified":"2026-05-16T11:35:30","modified_gmt":"2026-05-16T11:35:30","slug":"access-model-technology-as-key-to-managing-chronic-conditions-nelson-mullins-riley-scarborough-llp","status":"publish","type":"post","link":"https:\/\/www.insuracarelife.com\/blog\/access-model-technology-as-key-to-managing-chronic-conditions-nelson-mullins-riley-scarborough-llp\/","title":{"rendered":"ACCESS Model: Technology as Key to Managing Chronic Conditions | Nelson Mullins Riley & Scarborough LLP"},"content":{"rendered":"
\n

Providers caring for patients with chronic conditions have for years faced a persistent mismatch between how care is delivered and how Medicare pays for it. Managing chronic illness often requires ongoing monitoring, behavioral support and interventions outside traditional office visits, yet Medicare\u2019s fee\u2011for\u2011service (FFS) structure has historically only reimbursed discrete services, ignoring services that can provide sustained improvement in patient health.\u00a0 CMS has now acknowledged that by doing so it has been limiting the providers\u2019 ability to better scale technology\u2011enabled care, focusing on ongoing management rather than episodic treatment.<\/p>\n

Through its Center for Medicare and Medicaid Innovation (CMMI), on July 5, 2026, CMS has launched the ACCESS Model\u2014Advancing Chronic Care with Effective, Scalable Solutions\u2014as a voluntary, 10\u2011year test of whether an outcome\u2011aligned payment (OAP) approach can sustainably expand access to chronic care services not well supported through traditional Medicare reimbursement.<\/p>\n

Key Highlights of ACCESS<\/strong><\/h4>\n
    \n
  • Scope:<\/strong> Traditional Medicare reimbursement tied to management of specific chronic conditions<\/li>\n
  • Purpose: <\/strong>Testing whether outcome\u2011aligned payment improves care delivery<\/li>\n
  • Focus:<\/strong> Technology\u2011supported care for four high\u2011impact diagnoses<\/li>\n
  • Timeline:<\/strong> First phase begins July 5, 2026 (applications for this phase must have been submitted by April 1, 2026); applications submitted after April 1, 2026 and by October 1, 2026 will be considered for the next phase that begins January 1, 2027<\/li>\n
  • Participation Structure:<\/strong>\u00a0Voluntary, for a 10-year participation<\/li>\n<\/ul>\n

    Scope of ACCESS Model<\/strong><\/h4>\n

    ACCESS is structured around specific chronic conditions, rather than population\u2011wide risk, and focuses on conditions where CMS judges that ongoing management and prevention efforts have the greatest potential impact in FFS Medicare. The selected chronic conditions, also called \u201ctracks\u201d by CMS, affect more than two\u2011thirds of Medicare beneficiaries.\u00a0 They are:<\/p>\n

      \n
    • High blood pressure<\/li>\n
    • Diabetes<\/li>\n
    • Chronic musculoskeletal pain<\/li>\n
    • Depression<\/li>\n<\/ul>\n

      Organizations that participate in ACCESS must be Medicare Part B\u2013enrolled providers or suppliers, excluding certain categories such as durable medical equipment and laboratory suppliers. Eligible participants must designate a Medicare\u2011enrolled physician clinical director responsible for clinical oversight, quality, and compliance with model requirements, and must demonstrate the ability to furnish technology\u2011supported care for one or more of the model\u2019s qualifying chronic conditions. Because CMS evaluates applications based on organizational readiness, clinical leadership and the ability to meet detailed participation and reporting requirements, interested organizations will want to carefully assess their eligibility and application approach before submitting materials to CMS.<\/p>\n

      Outcome-Aligned Payments<\/strong><\/h4>\n

      A defining feature of ACCESS is its use of OAPs, which CMS describes as recurring payments tied to whether patients experience measurable improvement in their health over time. OAP measures are condition-specific metrics that hold participating providers accountable for beneficiary outcomes. Unlike traditional Medicare reimbursement driven by the volume of services provided, payment under ACCESS represents a shift toward aligned incentives: providers earn full payment only when beneficiaries meet OAP measure targets relative to each beneficiary\u2019s baseline.\u00a0<\/p>\n

      Outcome targets\u2014clear benchmarks for beneficiary success published by CMS\u2014are specific to the selected condition tracks and focus on either control or improvement of OAP measures. Beneficiary clinical data and patient-reported data are measured against the targets for condition tracks to which the beneficiary is aligned.<\/p>\n

      How Providers are Paid<\/strong><\/h4>\n

      The ACCESS model is designed to promote continued improvement and management of chronic illness over time. To this end, participating providers must submit monthly claims to CMS, and CMS will pay 100% of the projected annual OAP amount in monthly installments for the first 6 months of the 12-month care period. During the remaining 6 months (months 7 to 12) of the care period, CMS will withhold payment. After the 12-month care period, CMS will reconcile payment based on each beneficiary\u2019s achievement of OAP Measure targets. \u00a0This method continues annually during the term.<\/p>\n

      Technology as Key to Success<\/strong><\/h4>\n

      Technology plays a central role in the ACCESS Model, not as a separately reimbursed service, but as a core means by which participating organizations are expected to prevent and control chronic conditions between traditional clinical encounters. Integrated, technology\u2011supported care includes clinician consultations, lifestyle support, therapy and behavioral health counseling, patient education, diagnostic testing, care coordination, and medication management\u2014services historically difficult to sustain under FFS Medicare.<\/p>\n

      CMS has also made clear that ACCESS is designed to accommodate the use and monitoring of FDA\u2011authorized devices or software, as well as certain digital health technologies, without tying payment to any specific tool or platform. Instead, the model places responsibility on participating organizations to determine how technology could be incorporated into care delivery to facilitate continuous care, rather than stand\u2011alone reimbursable services.<\/p>\n

      As CMS continues to shift payment toward outcomes, ACCESS presents a meaningful opportunity for organizations to align care delivery with results, making early evaluation of fitness, capabilities, partnerships, and participation timing important strategic steps for providers navigating this evolving landscape.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

      Providers caring for patients with chronic conditions have for years faced a persistent mismatch between how care is delivered and how Medicare pays for it. Managing chronic illness often requires ongoing monitoring, behavioral support and interventions outside traditional office visits, yet Medicare\u2019s fee\u2011for\u2011service (FFS) structure has historically only reimbursed discrete services, ignoring services that can […]<\/p>\n","protected":false},"author":1,"featured_media":4614,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[496,3455,3456,1635,2132,1026,2453,2291,2290,2292,2293,1094],"class_list":["post-4613","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-access","tag-chronic","tag-conditions","tag-key","tag-llp","tag-managing","tag-model","tag-mullins","tag-nelson","tag-riley","tag-scarborough","tag-technology"],"_links":{"self":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/posts\/4613","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/comments?post=4613"}],"version-history":[{"count":0,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/posts\/4613\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/media\/4614"}],"wp:attachment":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/media?parent=4613"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/categories?post=4613"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/tags?post=4613"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}