CMS puts digital health into spotlight with ACCESS Model

Modern Healthcare – Tuesday, December 2, 2025
By Gabriel Perna

The Center for Medicare and Medicaid Innovation on Monday introduced a payment model that reimburses providers for using telehealth, wearables and other digital health technologies.

The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, which begins next year, will reward providers for improving outcomes for traditional Medicare beneficiaries with chronic conditions.

The model’s introduction comes at a challenging time for digital health. While Medicare telehealth and hospital-at-home reimbursement flexibilities were temporarily extended until Jan. 31, Congress’ inability to pass a long-term spending bill has left virtual care providers in a state of constant uncertainty.

The ACCESS Model becomes the latest example of the Centers for Medicare and Medicaid Services advocating for the use of telehealth, artificial intelligence and wearables to improve outcomes and reduce administrative burden on providers.

Here’s a look at CMMI’s ACCESS Model and what it means for providers.

What is CMMI’s ACCESS Model?

ACCESS is a voluntary payment model for Medicare Part B–enrolled organizations that are helping patients manage qualifying chronic conditions. The model aims to give providers a straightforward payment pathway when they use telehealth, wearables and smartphone applications to treat Medicare members with chronic conditions.

Providers will receive recurring payments for managing patients’ conditions. Full payment will be tied to achieving measurable health outcomes. The model will focus on clinical improvement of a condition based on each patient’s starting point.

What patients is the ACCESS model intended for?

The model is intended for patients who are on original Medicare rather than Medicare Advantage. While patients on Medicare Advantage traditionally have been allowed to use enhanced telehealth services, patients on original Medicare have had limited access to technology-supported care services.

What conditions does the ACCESS Model cover?

The conditions covered in the ACCESS Model fall into four buckets:

• Early cardiometabolic and kidney conditions: hypertension, dyslipidemia, obesity or being overweight
• Late cardiometabolic and kidney conditions: diabetes, chronic kidney disease and heart disease
• Musculoskeletal conditions: chronic musculoskeletal pain
• Behavioral health conditions: depression and anxiety

Organizations can participate in more than one clinical track, according to CMS.

What do participating organizations have to do?

Providers must offer tech-enabled care that may include coaching, behavioral support, patient education, medication management and other services that help manage chronic conditions. They also can use remote patient monitoring devices and wearables to monitor patients.

Providers participating in the model must use electronic health records that are connected with a patient’s primary care physician. They also must be integrated with a health information exchange to ensure referring physicians are receiving updates on their patients. Primary and referring physicians will be able to bill Medicare for ACCESS patients.

What type of providers should apply?

Any primary care or specialty provider that already engages in risk-based contracting for treating the conditions specified likely will be interested in applying, said Eric Musser, vice president of federal affairs at the National Committee for Quality Assurance, a nonprofit group that accredits healthcare organizations.

Accountable care organizations also likely will be interested, said Mara McDermott, CEO of Accountable for Health, a nonprofit advocacy organization focused on accelerating the adoption of effective accountable care. The model is designed to complement existing Medicare ACO models, she said.

When is the deadline to apply?

Providers must apply by April 1 to be considered for the model’s first performance period, which will begin July 1. The ACCESS Model is slated to run for 10 years, CMS said in a fact sheet.

What is the administration’s stance on digital health?

The ACCESS Model is the latest example of the Trump administration focusing on how digital health can be used to improve outcomes for Medicare populations.

In May, CMS and the Assistant Secretary for Technology Policy opened public comment on a variety of health IT topics including which digital health products should be covered for Medicare beneficiaries, the state of data interoperability and broader health technology infrastructure policies. The comments were published in June.

Health and Human Services Secretary Robert F. Kennedy Jr., and CMS Administrator Dr. Mehmet Oz have hosted multiple in-person sessions this year on how digital health can be used to improve data-sharing among payers, patients and providers as well as creating a modern data infrastructure for Medicare.

“This administration has been very clear they see opportunity for technology to drive innovation and improvement in clinical outcomes while reducing burden on patients, providers and payers,” Musser said. “The ACCESS model is clear evidence that they want to test that theory.”

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