Medicare Expands ACCESS Model to More Conditions — SkimNews
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- Medicare's ACCESS model was announced last year to pay approved companies that help manage chronic conditions, including diabetes, high blood pressure, chronic musculoskeletal pain, depression, and anxiety, using outcome-aligned payments that pay providers more when patients improve
- CMS regulators announced Tuesday they are expanding ACCESS to cover five additional conditions: substance use disorder, heart failure, chronic obstructive pulmonary disease (COPD), tobacco use, and longer-term support for musculoskeletal conditions
- New condition tracks are set to begin in spring 2027, according to officials
- About 3 in 4 Medicare beneficiaries will be eligible for at least one ACCESS track under the expanded model, officials said
- The pilot "has just barely gotten underway" yet officials are already moving to broaden its scope
Why it matters: Approved digital health and chronic-care companies now face a far larger Medicare market, with roughly 75% of beneficiaries qualifying for at least one ACCESS track. The outcome-aligned payment structure — rewarding providers only when patients improve — ties reimbursement to clinical results rather than service volume, fundamentally reshaping the revenue model for chronic-care tech firms operating in Medicare.
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