Last week, two things happened in Washington that, taken together, mark the most significant shift in chronic care economics since CMS introduced the original CCM codes a decade ago. If you run a health system, a medical group, or a value-based care organization, your strategy deck is now out of date.
On April 13, CMS announced that more than 150 organizations had been accepted into its new ACCESS Model, a 10-year experiment that pays providers based on whether patients with chronic conditions actually get better. On April 14, a bipartisan coalition introduced the Chronic Care Management Improvement Act of 2026, which would eliminate the 20 percent patient cost-share that has quietly suppressed CCM enrollment for a decade.
Two policy events. One thesis. The federal government is finally putting real money behind the proposition that managing chronic disease at home, with technology and licensed clinicians in the loop, is the cheapest and most effective way to bend the cost curve.
Here is what that means for your organization, and why the operators who move first will define the next decade of care delivery.
ACCESS Is Not Another Pilot. It Is a Floor.
CMS has launched a long list of innovation models since 2010, and most have ended quietly with mixed results. ACCESS is different in three specific ways.
First, it is built on Outcome-Aligned Payments. Participants receive recurring payments to manage patients with hypertension, diabetes, chronic musculoskeletal pain, anxiety, and depression, but full payment only flows when measurable outcomes improve. There is no checkbox economy here. You either move the clinical needle or you do not get paid the full amount.
Second, the duration is real. The model runs for ten years beginning July 5, 2026, with rolling applications through 2033. CMS designed this to give participants enough runway to actually build operating muscle, not stand up a pilot and disband it before the data matures.
Third, the appetite is real. CMS officials told STAT that applications exceeded internal expectations, and most accepted participants had not previously served Medicare patients. Translation: a wave of well-capitalized digital health and care management companies just got a federal green light to compete for chronic disease lives in your market. If your organization is not one of them, you are about to be downstream of the disruption.
The Cost-Share Bill Is the Quiet Earthquake
The Chronic Care Management Improvement Act of 2026 has not received the same coverage as ACCESS, and that is a mistake.
CCM as a billable service has existed for ten years. The clinical evidence is overwhelming. The financial returns to providers who run it well are real. And yet, national CCM enrollment has stayed in the single digits as a percentage of eligible Medicare beneficiaries. The reason is simple economics. A 78-year-old on a fixed income gets a phone call asking them to enroll in a service that will cost them roughly $12 a month, and a meaningful percentage say no.
The bill, which already has endorsements from the AMA, the AHA, AARP, and more than 40 other organizations, removes that friction entirely. If it passes, every conversation a care manager has about CCM enrollment becomes a yes question instead of a price question. The addressable market for chronic care services in fee-for-service Medicare expands by an order of magnitude overnight.
The political read here is also worth noting. Bipartisan support for a Medicare bill in 2026 is not an accident. It signals that both sides have concluded that subsidizing care management is cheaper than paying for the avoidable hospitalizations that follow when care management does not happen.
Why This Combination Is Existentially Important
Look at these two events together and the picture is unmistakable. CMS is paying for outcomes. Patients will no longer pay to participate. The two largest barriers to scaling chronic care management at the population level are being dismantled in the same week.
Health systems that have treated CCM and RPM as a side hustle, run by a small team, billed sporadically, and never integrated into the core care model, are about to face a structural disadvantage. The competitors who have built operational discipline around remote monitoring, evidence-based protocols, and continuous patient engagement will be eligible for the new payment streams. Everyone else will be playing catch-up.
This is not a software question. It is an operating model question. ACCESS rewards outcomes, and outcomes do not come from a portal or a dashboard. They come from a team that knows what to do when a blood pressure reading is out of range at 11 p.m. on a Sunday.
What Operating Discipline Actually Looks Like
At Welby Health, we built our model around a single belief: technology without clinical accountability is theater. That is why our platform pairs AI-powered workflows for vital sign monitoring, medication adherence tracking, and patient communication with licensed registered nurse case managers who actually own the outcome.
The data backs the model. Patients on our cellular-enabled blood pressure cuffs see an average 20 percent decrease in blood pressure. Patients using our smart glucose monitors see a 20 percent or greater reduction in blood glucose within four weeks. Heart failure patients in our program are 5.5 times more likely to adhere to the life-saving therapies their cardiologists prescribed. None of those numbers come from a software demo. They come from the combination of always-on monitoring and a human being who calls when something is off.
The reason I am writing this now is not to pitch our service. It is to make a strategic point. The ACCESS Model and the cost-share bill both reward exactly this kind of operating model and penalize the alternatives. Health systems and medical groups that have outsourced chronic care to a vendor who hands them a portal and walks away are about to discover they have no defensible asset. The vendors who can deliver clinical outcomes at scale will own the relationships, the data, and eventually, the patients.
The CEO Question for Q2
If you are a CEO, CFO, or CMO of a health system or provider organization, the question for the next 90 days is not whether to participate in chronic care management. That argument is over. The questions are sharper than that.
Do you have a partner or in-house operation that can produce outcomes good enough to qualify for ACCESS payments and the next generation of value-based contracts that will follow it? If patient cost-share goes to zero, can your team scale enrollment by an order of magnitude without breaking? When the new digital health entrants in your market start signing up your chronically ill patients directly, what is your defense?
These are not hypotheticals. The first ACCESS performance period starts July 5, 2026. Applications for the first cohort close May 15. The bill to eliminate cost-sharing has the broadest coalition of healthcare endorsers in recent memory. The window for being early is closing fast.
The operators who treat last week as a wake-up call will define the next decade of chronic care. The ones who do not will spend it explaining to their boards why their populations are being served by someone else.