For over a decade, stakeholders across the healthcare industry have told a story of transformation. The healthcare industry has daydreamed about value-based care. We've nodded along (and sometimes nodded off) at conferences as visions of transformation were illustrated with elaborate slide decks, and applauded pilot programs that promise to finally—finally—align payment with patient outcomes. And yet, when it comes time to truly tie reimbursement to whether a patient's blood pressure goes down or whether their blood sugar level improves, progress—and participation—have lagged. The concerns are familiar: patient behavior is unpredictable, social determinants are outside our control, outcomes are too hard to measure, and the risk is too high.
Over the last year, there have been echoes out of Washington that leaders were busy developing a new generation of payment models. Now, the Centers for Medicare & Medicaid Services (CMS) has articulated a model reflecting the administration’s vision to improve patient well-being using technology. On December 1, 2025, the CMS Innovation Center announced the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model—a 10-year voluntary program launching July 1, 2026 that does something no major Medicare initiative has done before: it pays providers based on whether patients actually get healthier. CMS will measure performance through biomarkers such as blood pressure, HbA1c, lipids, weight, and validated Patient-Reported Outcome Measures (PROMs) for pain, mood, and function.
The ACCESS Model creates a new category of Medicare Part B providers—ACCESS organizations—that can receive Outcome-Aligned Payments (OAPs) for managing qualifying chronic conditions. These are not fee-for-service payments for specific activities. They are recurring payments for managing a patient's condition, with the amount tied directly to whether the patient meets defined health outcome targets.
The model organizes conditions into four clinical tracks:
| Track | Conditions |
|---|---|
| Early Cardio-Kidney-Metabolic (eCKM) | Hypertension, dyslipidemia, obesity/overweight with central obesity marker, prediabetes |
| Cardio-Kidney-Metabolic (CKM) | Diabetes, CKD (Stage 3a or 3b), atherosclerotic cardiovascular disease |
| Musculoskeletal (MSK) | Chronic musculoskeletal pain |
| Behavioral Health (BH) | Depression and anxiety |
Each track has specific outcome measures and targets. For eCKM, that might mean getting a patient's blood pressure to target. For CKM, achieving HbA1c control. For MSK and BH, validated improvements in patient-reported pain, mood, and function.
CMS isn't measuring whether you tried. They're measuring whether it worked.
Here's where it gets real: CMS determines payment based on the overall share of an organization's patients who meet the outcome targets compared to a minimum threshold that increases each year. If your patients aren't getting better, you're not getting paid—at least not fully.
The concept of value-based care often carries a tagline that goes something like “pay for good outcomes, not the volume of services.” We’ve been at the value-based care table for decades, and while we consistently see savings and better patient outcomes in programs like MSSP, we are not yet seeing the full promise of value-based care. In some circles, the term value-based care has even taken on a negative connotation. Our attempts to provide value to patients, not volume, has resulted in confounding and confusing payment models that often do not result in what Medicare patients really want: to feel better, to have more good days, to be more active, and to take those vacations.
These complex payment models arose out of necessity, though. It’s historically been incredibly difficult to pay based on outcomes.
Patient behavior is notoriously difficult to influence. You can prescribe the best medication, design the perfect care plan, and provide continuous support—and your patient might still eat a poor diet because they live alone and cooking makes them feel lonely, not adhere to medication because of unwanted side effects, or forgetting to refill prescriptions, and miss follow-up appointments because they don’t have anyone to drive them. Providers have long felt that tying their compensation to patient outcomes is unfair because they can't control what happens once the patient leaves the office.
Disagreement on measures. Even in value-based care programs like MSSP and ACO REACH, the risk is largely around managing utilization and total cost of care—not achieving clinical outcomes for specific conditions. Providers can influence emergency room visits and unnecessary hospitalizations through care coordination. But being held financially accountable for whether a patient's A1c drops from 9.5% to 7.0%? That's a different level of exposure. To make matters even more complex, for many chronic diseases, there is ongoing debate among physicians about which outcome measures are the “right” ones to track. That disagreement has largely led to an avoidance of direct payment for good outcomes.
The measurement infrastructure wasn't there. Until recently, tracking condition-specific outcomes at scale required either burdensome manual data collection or expensive technology solutions that weren't worth the investment under fee-for-service.
All these concerns are real. They're also, as of December 2025, no longer valid. The cost of healthcare, specifically Medicare, is growing at untenable levels. With ACCESS, CMMI is creating an exciting opportunity to see what happens when we do exactly what value-based care was intended to do.
What makes the ACCESS Model different from prior experiments in outcome-based payment is the explicit recognition that technology-enabled care is the key to scalable chronic disease management. The model allows—and expects—care to be delivered through:
ACCESS acknowledges that meaningful chronic disease management requires meeting patients where they are, with the right level of support, delivered at the right time. The organizations that succeed in this model are those that deploy technology to scale high-touch care in cost-effective ways.
While now technologically possible, succeeding will require operational capabilities, including:
Not every organization is ready for ACCESS. Those who will thrive have already made the philosophical shift to population health. Financially, they’ve shown the discipline to invest prepaid revenue in program improvement and improved outcomes. Clinically, they've invested in care management. Technically, they've established robust data and analytics capabilities. Culturally, they understand that managing chronic disease is about consistent, systematic, technology-enabled engagement that compounds over time.
It is critical to understand that new entrants will pursue opportunities in new modes of chronic disease care funded under the ACCESS model. This disruption will impact incumbent participants in value-based payment, and they should carefully consider the risks of sitting on the sidelines.
CMS has made the trade-off explicit: if you can consistently improve patient outcomes, you can receive meaningful, recurring payments without the administrative burden of documenting and billing for every discrete activity. But this opportunity will be budget-neutral—and so there may be competition to own the credit for performance and savings. Many organizations that were hands-off around medical expense management or that weakly managed quality in legacy CMMI models may find their margin being impacted by new entrants who are driving squarely at disease-specific value opportunities via the ACCESS model.
This is a moment of disruption. Not disruption as a buzzword, but disruption in the sense that it is a new approach that starts at the margins, addresses needs the existing system struggles with, and has the potential to fundamentally change how an industry operates.
Outcome-based payment is here. The question is now whether you’re ready to walk the walk.