Understanding CMS ACCESS: A New Era of Outcome-Based Care

CMS Access Explained: What You Need to Know

For years, the healthcare industry has discussed the shift from volume to value. With the introduction of the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, CMS is taking a definitive step toward making that transition a reality for millions of Americans. 

Starting July 5, 2026, this 10-year voluntary ACCESS model will test a new way for Medicare to pay for technology-supported care. Instead of paying for every individual phone call or device, CMS will use Outcome-Aligned Payments (OAPs). In simple terms: clinicians get paid when patients actually get healthier.

Why CMS is Launching ACCESS

Today, many people with Original Medicare face barriers to using modern tools like remote patient monitoring or digital health apps because traditional fee-for-service payments don't always cover them. The ACCESS model removes these barriers, focusing on conditions that affect more than two-thirds of Medicare beneficiaries, including:

• Hypertension and High Cholesterol (Early Cardio-Kidney-Metabolic track)
  
  • This includes high blood pressure (hypertension), but also covers potential risk factors if a member has any combination of dyslipidemia, obesity or overweight with marker of central obesity, or prediabetes
• Diabetes and Chronic Kidney Disease (Cardio-Kidney-Metabolic track)
  
  • This track covers conditions like diabetes mellitus and chronic kidney disease but also conditions like atherosclerotic cardiovascular disease and heart disease.
• Chronic Pain (Musculoskeletal track)
  
  • This is for members living with chronic musculoskeletal pain.
• Depression and Anxiety (Behavioral Health track)
  
  • This track looks at behavioral health, particularly depression and anxiety.

Key Pillars of the ACCESS Model

Decision-makers, product innovation experts, and member experience executives at payors or digital health companies must understand these guidelines for effective roadmap development. These pillars are designed to move the needle on some of the conditions most important to member health. 

1. Reward for Results: Full payment is tied to achieving measurable health goals, such as a 10 mmHg reduction in blood pressure or a decrease in HbA1c levels.
2. Technology-First Care: The model encourages the use of FDA-authorized devices, telehealth, and asynchronous care to support patients continuously, rather than just during office visits. 
3. Enhanced Coordination: Primary care physicians (PCPs) can bill a new co-management payment for reviewing updates from technology-enabled care teams, ensuring everyone is on the same page. 

How Ash Solves the ACCESS Challenge

The ACCESS Model requires organizations to be high-performing and data-driven. Participating organizations will be responsible for managing qualifying conditions that a member has within a particular track; this is all in the name of supporting integrated, patient-centered care. To earn full payment, you must prove your patients are hitting their clinical targets. Offering solutions for each track and delivering on results is where Ash becomes an essential partner for your clinical strategy.

• At-Home Testing for Better Compliance: Whether you need a comprehensive cholesterol panel or a metabolic panel to test for GLP-1 eligibility, Ash provides at-home lab test kits that remove the friction of visiting a lab. 
• Seamless Gap Closure: High-performing ACCESS organizations will need to regularly submit data like urine albumin-creatinine ratio (UACR) or lipids. Ash’s infrastructure allows for blood sample collection at home - via traditional methods like DBS or newer methods like Tasso - ensuring you have the data needed to prove outcomes without the patient ever leaving their house.
• Scalable Remote Patient Monitoring: As the model rewards the control or minimum improvement of biomarkers, our home health testing and remote patient monitoring solutions provide the consistent touchpoints necessary to adjust care plans in real-time. 

Moving Forward

The CMS Access guidelines signal a permanent shift toward accountability. Whether you are a digital health company looking to become an ACCESS care organization or a payer looking to adopt similar outcome-aligned structures for your Medicare Advantage members, the right technology partner is key.

Ash provides the reliable, knowledgeable, and engaging testing experience that helps your members reach their health goals—and helps your organization reach its performance targets.

If you’d like to learn more about Ash and our solutions, we’d love to chat. 

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