Medicare's New Tech-Powered Chronic Care Program: What You Need to Know About ACCESS

If you're on Medicare and managing chronic conditions like heart disease, diabetes, or arthritis, a major shift is coming to how your care might be delivered and paid for. The Centers for Medicare & Medicaid Services (CMS) just opened applications for a groundbreaking new program called ACCESS (Advancing Chronic Care with Effective, Scalable Solutions), which fundamentally changes how healthcare providers get compensated—moving from paying for each visit to paying for actual health improvements.

How ACCESS Works: Results Over Visits

Here's what makes ACCESS different from traditional Medicare. Instead of doctors and clinics getting paid for every appointment or test, providers in this program receive Outcome-Aligned Payments (OAPs)—recurring payments that depend on whether patients actually get better. Think of it as Medicare saying, "We'll pay you if your patients hit specific health targets, not just if they show up."

The payment structure is designed to encourage accountability. CMS pays part of the fee upfront each quarter, but holds back 50 percent until the end of the year. That withheld amount depends on two things: whether patients achieve their clinical targets (like better blood sugar control or improved kidney function) and whether they're not getting duplicate services elsewhere. This "substitute-spend test" prevents patients from getting billed twice for the same condition.

Which Conditions Are Covered?

ACCESS launches with four clinical tracks focused on common, chronic conditions where technology-supported care has strong evidence of working: Early Cardio-Kidney-Metabolic (eCKM), Cardio-Kidney-Metabolic (CKM), Musculoskeletal (MSK), and Behavioral Health (BH). These conditions were chosen because they're widespread among Medicare beneficiaries and have established care pathways that work well with digital tools.

The Technology Piece: Why It Matters

ACCESS isn't just about changing payment—it's built on the assumption that providers will use modern digital health tools. The program requires participants to use FHIR-based APIs (essentially, standardized digital bridges that let different health systems talk to each other securely). This means your doctor's office can share your health data with specialists, your wearable devices, and telehealth platforms without you having to manually transfer information.

CMS is also coordinating with the FDA through a pilot program called TEMPO (Technology-Enabled Meaningful Patient Outcomes), which allows up to 40 digital health device manufacturers to participate and generate real-world evidence. This coordination is designed to reduce barriers to innovation and get safe, effective digital tools into the hands of patients faster.

Who Can Join and When?

Not every provider can participate. Organizations must be Medicare Part B-enrolled providers or suppliers (though certain types like labs and durable medical equipment suppliers are excluded). The program is designed for organizations with mature clinical operations and solid data infrastructure—essentially, those already equipped to handle complex care coordination.

Applications for the first performance period are due April 1, 2026, with the program launching in July 2026. Organizations that miss that deadline can apply for a January 1, 2027 start. Since ACCESS is a rolling, decade-long initiative, some organizations may choose to enter later.

What This Means for You as a Patient

Here's the practical side: if your provider joins ACCESS, your participation is completely voluntary. You can choose to enroll, and you can switch to a different ACCESS provider every 90 days if you want. CMS plans to publish a public directory showing which providers participate, what conditions they treat, their cost-sharing policies, and their outcomes—so you can compare and make informed choices.

The program focuses on relatively stable, chronically ill beneficiaries, so it's not designed for acute or severe conditions. But if you have multiple qualifying conditions within a track (say, both heart disease and kidney disease), your provider takes responsibility for managing all of them.

The Bottom Line

ACCESS represents Medicare's most explicit push yet toward outcomes-based, technology-enabled care in traditional Medicare. It's a bet that when you align financial incentives with actual health improvements and give providers modern digital tools, everyone wins—patients get better care, providers get rewarded for results, and Medicare saves money. Success will depend on providers combining clinical excellence with strong patient engagement and seamless data sharing. For you, it means potentially better-coordinated care, more use of digital health tools, and providers who are financially motivated to help you actually get healthier.