On April 13, the Centers for Medicare and Medicaid Services greenlit more than 150 organizations to participate in the ACCESS Model, a 10-year experiment that pays providers based on whether their chronic disease patients actually get better. Most coverage treated it as another CMMI pilot. It is not. ACCESS is the clearest signal yet that the chronic care economics in Original Medicare are about to be rewritten, and the operating model that wins under those new rules looks very different from the one most health systems run today.
If you lead a health system, a multispecialty group, a payer, or a digital health company, you should already have a plan for what your organization does on July 5, 2026, the day ACCESS goes live. If you do not, the next 1,200 words are for you.
ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. It runs from July 5, 2026, through June 30, 2036. Participants will receive recurring per-beneficiary payments for managing qualifying conditions, with the catch being that full payment only flows when at least 50 percent of aligned beneficiaries hit their outcome targets in year one. The model focuses on six high-prevalence, high-cost conditions: diabetes, hypertension, high cholesterol, musculoskeletal pain, anxiety, and depression.
Two details matter more than the headline. First, ACCESS is voluntary, but it is also outcome-aligned, which means it sits structurally closer to the future of value-based care than to the upside-only ACO programs that have dominated Medicare for the last decade. Second, CMS approved more than 150 participants out of an applicant pool that included hospital systems, physician groups, and digital health companies. That is the largest tech-forward chronic care cohort the agency has ever assembled.
Read between the lines. CMS has decided that the next phase of value-based care will not be built primarily by traditional ACOs. It will be built by organizations that can deploy connected devices, AI-powered workflows, and continuous patient engagement at scale, and that can prove outcomes month after month.
Three converging forces make ACCESS more consequential than its participant count suggests.
The first is the Chronic Care Management Improvement Act of 2026, introduced on a bipartisan basis on April 14. The bill would eliminate the 20 percent Medicare beneficiary coinsurance on CCM services. That coinsurance is small in dollar terms, often around 12 dollars a month, but it is the single biggest enrollment barrier providers face when they try to scale CCM programs. If it passes, CCM volume in Original Medicare will jump materially, and the operating systems that can absorb that volume profitably will eat the market.
The second is the rebuild of the RPM fee schedule that took effect January 1. CMS finally created CPT codes 99445 and 99470 to allow billing for two to fifteen days of measurements, complementing the existing 16-day code 99454. Providers can now bill RPM for medication titration, GLP-1 weight management, transitional care, and other intermittent-monitoring use cases that used to be uneconomic. The addressable RPM population in Medicare just expanded by a meaningful multiple.
The third is the workforce reality. The U.S. is on track for the equivalent of 358,000 vacant nursing positions by 2026, and more than 50 percent of registered nurses are 50 or older. You cannot run a chronic care program at scale by hiring your way out of this. The only paths that work are technology-enabled clinical leverage and partnerships with organizations that have already built it.
Stack those three forces together. CMS is paying for outcomes, expanding the billable surface area for chronic care, and operating in a workforce environment that punishes any model dependent on linear staffing. ACCESS is the proof point, not the program.
The chronic care operating model that produces outcomes under ACCESS shares four characteristics.
It starts with licensed clinical staff working at the top of license. At Welby Health, licensed RN case managers run the relationships, make the clinical judgments, and document for billing. AI does not replace nurses in this model. It makes them three to five times more productive by handling triage, vital sign trending, medication adherence tracking, and patient outreach drafting.
It runs on connected devices that produce clinically actionable data. Cellular-enabled blood pressure cuffs in our population deliver a 20 percent reduction in systolic blood pressure. Smart glucose monitors deliver greater than 20 percent blood glucose reduction in four weeks. Heart failure patients on continuous remote monitoring are 5.5 times more likely to adhere to guideline-directed therapy. These are exactly the outcome deltas ACCESS will pay for.
It is built around AI workflows that flag rising risk before it becomes a hospital admission. Our MARKUS clinical AI platform watches every patient continuously, surfaces the ones trending toward trouble, and routes them to a nurse with context attached. The cost of missing a rising-risk diabetic in 2024 was an avoidable admission. Under ACCESS, the cost is also a missed outcome payment.
It generates revenue. The same operating model that produces ACCESS outcomes also generates new billable CCM, RPM, and TCM revenue for partner organizations. In a margin-compressed environment, this is the only chronic care strategy that finance teams can defend.
A fair counterpoint deserves a hearing. MIT Technology Review ran a piece on April 24 questioning whether healthcare AI actually helps patients. The skepticism is healthy. Most healthcare AI deployed today is not paired with a clinical workflow that turns model outputs into measurable patient action. The answer is not less AI. The answer is AI that lives inside a clinical operation accountable for outcomes, which is exactly what ACCESS will start measuring.
Assume an average primary care panel of 1,500 Medicare beneficiaries, of whom roughly 60 percent have two or more chronic conditions, the threshold for CCM eligibility. That is 900 patients per panel. Most practices today enroll less than 20 percent of that eligible population in CCM because of the cost-sharing barrier, the documentation burden, and the staffing gap. If the CCM Improvement Act passes and outcome-aligned models like ACCESS expand, the practical operating ceiling moves toward 60 to 80 percent enrollment.
For a 50-physician group, that delta translates into thousands of net new chronically managed patients, low seven-figure annual incremental revenue from CCM and RPM codes alone, and a measurably better readmission and ED utilization profile. For a health system at scale, the numbers compound from there. None of it materializes if the operating model is not in place by mid-2027 at the latest.
The CEOs I talk to are not debating whether to build chronic care capacity. They are debating build versus buy versus partner, and how fast they can move. ACCESS just shortened that decision window.
First, do we have a chronic care operating model that can hit a 50 percent outcome threshold under ACCESS, or a credible path to one by July 2027 when the next cohort opens?
Second, what is our point of view on outcome-aligned payments more broadly, and is our finance organization modeling the upside of CCM Improvement Act passage?
Third, are we partnered with the right tech-enabled clinical operator, or are we still planning to build this in-house with traditional staffing models that the workforce data says do not exist?
The 150 organizations CMS just selected are placing their bets. The first outcomes data will land in mid to late 2027. By the time the rest of the market reacts, the operating playbook will already be priced in.
The window to act on your terms, with your partners, at your price, is open right now. It is also closing faster than most health system boards realize.