Chronic disease is not a new problem in Medicare — but it is a problem that is persistent, expensive, and stubbornly resistant to the payment structures designed around it. More than two-thirds of Medicare beneficiaries live with at least one chronic condition. Many carry several, layered and compounding: hypertension alongside diabetes, chronic kidney disease accelerating cardiovascular risk, depression sitting quietly beneath every cardiometabolic diagnosis. The clinical complexity has been understood for decades. What has been missing is a payment model designed to address it at scale.

The CMS ACCESS Model — Advancing Chronic Care with Effective, Scalable Solutions — is a direct response to that gap.

Medicare’s Chronic Care Problem Just Got a Structural Answer

Launching July 5, 2026, the ACCESS Model is a 10-year national Medicare initiative that shifts reimbursement away from service volume and toward a question that has historically gone unanswered in fee-for-service: did health actually improve?

Under ACCESS, participating organizations receive Outcome-Aligned Payments (OAPs) — recurring reimbursements tied not to what care was delivered, but to the proportion of their enrolled population meeting defined clinical outcome targets. The model organizes its focus across four clinical tracks, each targeting conditions that are among the most prevalent and most costly in Medicare:

  • Early Cardio-Kidney-Metabolic (eCKM): Hypertension, dyslipidemia, obesity, and prediabetes — the upstream risk factors that, left unmanaged, drive progression to more serious disease.
  • Cardio-Kidney-Metabolic (CKM): Established disease: diabetes, chronic kidney disease (CKD), and atherosclerotic cardiovascular disease (ASCVD).
  • Musculoskeletal (MSK): Chronic musculoskeletal pain.
  • Behavioral Health (BH): Depression and anxiety — conditions that appear as comorbidities across virtually every cardiometabolic diagnosis in the model.

This architecture is deliberate. The conditions ACCESS targets do not present in isolation. A Medicare patient with diabetes frequently carries hypertension. A patient with chronic kidney disease is likely managing cardiovascular risk. Depression and anxiety are among the most common comorbidities across the entire cardiometabolic spectrum. ACCESS is designed to reward organizations that can manage that complexity whole — not track by track in isolation, but as the integrated clinical picture it actually is.

More than 150 organizations have been accepted into the inaugural cohort, with CMS accepting applications on a rolling basis through 2033. The model’s reach is, by design, nearly universal: the conditions it targets affect the majority of the Medicare population, and its public reporting of risk-adjusted outcomes will make performance differences visible across participating organizations over time. This is not a pilot. It is a template.

Participation Is Not the Same as Performance

The shift toward outcome-aligned payment is directionally clear. What is less certain — and what will determine which organizations thrive under ACCESS over its decade-long run — is whether they can execute against it.

ACCESS requires participating organizations to demonstrate operational readiness before a single patient is enrolled: eligibility tracking, outcome measurement, audit-defensible workflows, and CMS-aligned reporting through FHIR-based APIs. During participation, they must maintain period-based snapshots of patient status, report clinical outcomes at the population level, and withstand CMS audit scrutiny across every eligibility decision and status transition. CMS will publicly report risk-adjusted outcomes across all participants — creating accountability that is structural, not aspirational, and visible to patients, referring clinicians, and the market alike.

For most primary care organizations, meeting these requirements is a significant operational undertaking. The gap between clinical intent and execution infrastructure is precisely where many value-based care initiatives have stalled before ACCESS. Here, that gap is financially consequential and publicly visible in a way previous models were not.

But operational compliance is only the floor. Technology-enabled chronic disease management — delivering care through telehealth, remote patient monitoring, and digital health tools — is the baseline ACCESS explicitly requires. An organization that has digitized its workflows and connected its devices has met the entry point. What determines performance over a 10-year outcome-aligned model is the ability to move upstream from that baseline: from managing chronic conditions after they are established to identifying them before they progress.

The Shift From Managing Disease to Predicting It

The chronic conditions ACCESS targets are among the most clinically predictable in medicine. The trajectory from prediabetes to diabetes, from early-stage chronic kidney disease to advanced renal failure, from controlled hypertension to cardiovascular event — these are not random outcomes. They are the products of clinical signals that accumulate in patient records over time, often visible long before a condition crosses a threshold that triggers intervention under conventional care management.

This is the distinction between technology-enabled chronic disease management and predictive chronic disease management — and it is a distinction that will separate high-performing ACCESS participants from those that merely participate. Organizations that can surface those longitudinal signals systematically, act on them earlier, and demonstrate measurable population-level improvement will perform. Those that manage conditions reactively, enrolling patients only after disease is established, will find ACCESS’s outcome targets increasingly difficult to sustain year over year.

The analytical infrastructure required to make that shift — AI-driven analysis of patient medical records and healthcare data at the population level, identifying early-onset CKM and complex comorbidities before they progress — is not something most primary care organizations have built natively. It is where AI platforms purpose-built for healthcare operations become the critical execution layer: turning data that already exists in health records into predictive clinical action, and pairing that capability with the eligibility tracking, outcome status management, period-based audit trails, and reporting workflows that support optimization of interventions and care delivery at the provider level.

Bloom Value’s FAST Platform brings this combination to healthcare organizations navigating ACCESS. When Blossom Ridge Medical Inc., a primary care clinic in Sacramento, was accepted into ACCESS across all four clinical tracks ahead of the July 2026 launch, it was this predictive and operational infrastructure that made that readiness real.

“Bloom Value’s AI platform has given us the ability to analyze patient records in depth, identify early-onset CKM and complex comorbidities, and act earlier — which is the clinical intent behind ACCESS.”

— Dr. Glenda Agustin, Medical Director, Blossom Ridge Medical Inc.

A Ten-Year Model With Implications Beyond ACCESS

ACCESS is not an isolated initiative. It is part of a broader, sustained directional shift in Medicare — toward outcome accountability, cost transparency, and technology-enabled care at scale. Its 10-year horizon, public outcome reporting, and rolling application window through 2033 signal that CMS views ACCESS not as an experiment but as a durable framework. If the model demonstrates that outcome-aligned payment improves quality without increasing costs, CMS has the authority to expand or make it permanent.

The question ACCESS is asking — not what care was delivered, but whether health improved — will shape Medicare reimbursement well beyond this model’s boundaries. Organizations built for risk-bearing and population health management that build the predictive and operational infrastructure to answer it now will carry a structural advantage as that shift accelerates. And the AI platforms enabling that infrastructure will be defining what execution looks like at the frontier of value-based care.

“ACCESS moves Medicare toward a fundamentally different question — not what care was delivered, but whether health improved. The FAST platform answers that question — through predictive chronic disease management and optimization of interventions and care delivery, where every clinical decision is traceable, measurable, and tied to outcomes.”

— Arun Hampapur, CEO, Bloom Value

For organizations accepted into the July 2026 cohort, the work of execution begins now. For those planning for the January 2027 start and beyond, the window to build genuine execution readiness — not just participation — remains open, but not indefinitely.

To learn how Bloom Value’s FAST platform can support your ACCESS execution strategy, contact us today.

Frequently Asked Questions

Q1. What is the CMS ACCESS Model?

The ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year voluntary Medicare initiative launched by the CMS Innovation Center (CMMI). It introduces Outcome-Aligned Payments for organizations delivering technology-supported chronic disease management to Medicare beneficiaries, tying reimbursement to measurable health outcomes rather than service volume. The model launches July 5, 2026, and runs through June 30, 2036. Learn more on the official CMS ACCESS Model page.

Q2. What are the four clinical tracks in the ACCESS Model?

ACCESS is structured across four tracks: Early Cardio-Kidney-Metabolic (eCKM), covering hypertension, dyslipidemia, obesity, and prediabetes; Cardio-Kidney-Metabolic (CKM), covering diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease; Musculoskeletal (MSK), covering chronic musculoskeletal pain; and Behavioral Health (BH), covering depression and anxiety.

Q3. What is predictive chronic disease management?

Predictive chronic disease management applies AI-driven analysis of patient records and healthcare data to identify early-onset chronic conditions and complex comorbidities before they progress — enabling earlier clinical intervention and improving the likelihood of measurable outcome improvement at the population level. This goes beyond standard remote patient monitoring and telehealth to proactively surface risk signals from existing health records.

Q4. What is the difference between technology-enabled and predictive chronic disease management?

Technology-enabled chronic disease management refers to delivering care through digital tools, telehealth, and remote monitoring — the baseline ACCESS requires. Predictive chronic disease management goes further, using AI and machine learning to identify clinical risk signals before conditions progress, enabling earlier intervention and better population-level outcomes. The distinction is the difference between reacting to established disease and preventing its progression.

Q5. What operational infrastructure does ACCESS participation require?

ACCESS participants must demonstrate eligibility tracking, outcome status management, period-based audit trails, and CMS-aligned reporting through FHIR-based APIs before participation begins. CMS will publicly report risk-adjusted outcomes across all participants, making operational rigor a financial and reputational requirement — not just an administrative one. Bloom Value’s FAST platform is purpose-built to support these requirements.

Q6. What role do AI platforms play in ACCESS execution?

AI platforms enable healthcare organizations to move beyond administrative compliance into predictive performance — analyzing patient data to surface early-onset chronic disease risk, optimizing interventions and care delivery, and maintaining the audit-defensible workflows ACCESS demands across a 10-year outcome-aligned model. Bloom Value’s Risk Optimization solution supports IPAs, ACOs, and risk-bearing organizations in achieving these goals.

Q7. Who is eligible to participate in the CMS ACCESS Model?

Eligible organizations must be Medicare Part B-enrolled providers or suppliers (excluding DME and laboratory suppliers) and designate a Medicare-enrolled Clinical Director. Medicare Advantage plans are not eligible for ACCESS participation. Organizations operating under ACO or other risk-bearing arrangements can complement those models with ACCESS participation. Applications are accepted on a rolling basis through 2033.

Q8. How are Outcome-Aligned Payments (OAPs) calculated under ACCESS?

CMS determines OAPs based on the share of aligned Medicare beneficiaries who meet guideline-informed outcome targets for their clinical track. For 2026, full payment is earned if at least 50% of patients meet all required outcome measures — this threshold, called the Outcome Attainment Threshold (OAT), increases each year. CMS also applies a Substitute Spend Adjustment to minimize avoidable duplicate services, and a fixed rural payment enhancement to promote equitable access.

Q9. How are healthcare organizations building execution readiness for the CMS ACCESS Model?

Leading organizations are approaching ACCESS execution across two dimensions: predictive clinical capability and operational infrastructure. On the clinical side, AI platforms are being deployed to analyze patient medical records and healthcare data at the population level — identifying early-onset CKM and complex comorbidities before conditions progress. On the operational side, the focus is on eligibility tracking, outcome status management, period-based audit trails, and CMS-aligned reporting workflows. Bloom Value’s FAST platform brings both dimensions together for healthcare organizations navigating ACCESS.

Blossom Ridge Medical Inc., accepted into ACCESS across all four clinical tracks ahead of the July 2026 launch, built ACCESS readiness using Bloom Value’s FAST platform. Contact us to learn how we can support your organization.