Last updated: December 5, 2024 | We'll continue updating this guide as CMS releases more details about ACCESS requirements and reporting.

If you deliver tech-enabled chronic care, you probably heard the news: CMS just announced a massive Medicare opportunity for digital health.

The ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year program that finally creates a real Medicare payment pathway for the kind of care our customers deliver every day: longitudinal, technology-supported, outcomes-focused care for people living with chronic conditions.

We're here to help you understand what it means and how to take advantage of it.

The Big Picture: Why ACCESS Matters

Here's the problem ACCESS is solving: Medicare has never had a great way to pay for tech-enabled care.

Traditional Medicare pays for activities - a visit here, a procedure there. But that's not how modern chronic care works. When you're helping someone manage diabetes, hypertension, anxiety, or chronic pain, you're building a relationship over months and years. You're using apps, remote monitoring, coaching, and virtual check-ins. You're focused on outcomes - did their blood pressure improve? Are they feeling less anxious?

ACCESS flips the script. Instead of billing for each individual touchpoint, participating organizations receive recurring payments tied to actually improving patient health. CMS is calling these "Outcome-Aligned Payments" - and they're exactly what they sound like: get paid for getting results.

The conditions covered affect roughly two-thirds of all traditional Medicare beneficiaries. That's a massive population that can now access the kind of technology-supported care that's been transforming commercial and Medicare Advantage markets.

What Conditions Are Covered?

ACCESS focuses on four clinical tracks:

🫀 Early Cardio-Kidney-Metabolic (eCKM) For earlier-stage conditions: hypertension alone, OR two or more of the following: high cholesterol, obesity/overweight, or prediabetes. This track focuses on prevention and stopping progression before conditions become more serious.

🫀 Cardio-Kidney-Metabolic (CKM) For more established conditions: diabetes, chronic kidney disease (Stage 3a/3b), or cardiovascular disease. Outcomes measured include blood pressure, HbA1c, cholesterol, weight, and kidney function.

🦴 Musculoskeletal (MSK) Chronic pain lasting more than 3 months. Outcomes are measured through validated patient-reported assessments of pain and function.

🧠 Behavioral Health (BH) Depression and anxiety. Outcomes are measured using standard tools like PHQ-9 and GAD-7.

The two CKM tracks are actually a smart design choice by CMS - it means organizations can work with patients at different stages of their health journey, from early intervention (eCKM) through more complex chronic disease management (CKM).

If your organization delivers care for any of these conditions - whether that's diabetes management, virtual MSK programs, behavioral health support, or integrated chronic care - ACCESS creates a pathway to sustainably serve Medicare patients.

Key Dates to Know

Applications open: January 12, 2026

First cohort application deadline: March 20, 2026

First cohort launches: July 1, 2026

The program runs through: June 30, 2036

The January 12, 2026 date is approaching quickly! If you're interested in participating, now is the time to start preparing.

What Does CMS Require? (The Short Version)

We're still waiting for CMS to release the full Request for Applications with all the details. But here's what we know so far about what participating organizations will need:

• A physician Clinical Director – Every ACCESS participant needs a Medicare-enrolled MD or DO overseeing clinical quality and compliance.
• Outcomes tracking and reporting – You'll need to capture baseline health data for each patient, track their progress, and report outcomes to CMS through their APIs.
• Interoperability with primary care – ACCESS is designed so tech-enabled care complements the patient's primary care relationship, not replaces it. You'll need to share care plans and updates with referring providers through secure, electronic means.
• Flexible care delivery – Good news: CMS isn't mandating how you deliver care. Virtual, in-person, asynchronous, app-based – use whatever approach works best for your patients and your model.

How Healthie Supports ACCESS Participation

Here's the thing: ACCESS isn't asking for anything new from Healthie customers. The model rewards exactly what our platform was built to do — longitudinal, outcomes-focused, technology-enabled care delivered by collaborative care teams.

Healthie already powers 40,000+ clinicians supporting 15+ million patient lives across behavioral health, nutrition, chronic disease management, and more. We're ONC-certified, HIPAA and HITRUST compliant, and API-first by design. When CMS describes what ACCESS participants need, they're describing what Healthie customers already have.

📊 Track Outcomes From Day One

ACCESS pays for results, which means you need to measure them. Healthie's Goals and Metrics let you set clinical targets (blood pressure, weight, HbA1c) and track progress over time. Our Forms and Assessments capture the validated patient-reported outcome measures ACCESS requires—PHQ-9, GAD-7, pain scales, functional assessments—and tie them directly to the patient record. No spreadsheets, no workarounds. Baseline to outcome, all in one place.

📱 Integrate Remote Monitoring Seamlessly

For CKM and eCKM tracks, especially, connected devices are table stakes. Through Healthie's API and our Harbor marketplace of 70+ integrations, blood pressure cuffs, glucose monitors, weight scales, and other RPM devices feed data directly into patient charts. Your care team sees the full picture without toggling between systems.

🤝 Collaborate Across Care Teams and Share Data With PCPs

ACCESS is built around coordination — tech-enabled care that works with primary care, not around it. Healthie's API-first architecture supports the interoperability ACCESS demands. Our platform is designed for multi-provider, multi-disciplinary care teams, with shared records, task assignment, and internal messaging that keeps everyone aligned. When CMS says you need to share care plans electronically with referring providers, Healthie's infrastructure is ready.

💬 Deliver Care However It Works Best

Virtual visits. Async messaging. Coaching programs. In-person sessions. Patient apps. ACCESS doesn't prescribe how care happens—and neither does Healthie. Our telehealth, chat, Programs (our built-in LMS), and patient engagement tools give you the flexibility to design care models that actually work for your patients. Whether someone needs a weekly video check-in or daily app-based support, you can build it in Healthie.

📋 Stay Compliant Without the Overhead

Medicare programs mean documentation requirements. Healthie's EHR, charting, and scheduling tools keep your clinical team focused on patients while capturing what you need for compliance and reporting. We're HIPAA, HITRUST, SOC-2 Type 2, and ONC certified — the compliance foundation that Medicare participation requires.

🚀 Scale Without Rebuilding

ACCESS is a 10-year program. Organizations that participate will need technology that can grow with them, from the first cohort to a national scale. Healthie's platform already supports organizations ranging from solo practitioners to enterprise digital health companies. Our infrastructure is built to scale, and our API means you're never locked into a single way of doing things.

Bottom line: If you're considering ACCESS, you don't need to rip and replace your tech stack or build custom infrastructure from scratch. Healthie customers are already operating on a platform designed for outcomes-focused, longitudinal, tech-enabled care. ACCESS is just Medicare finally catching up to the way care should be delivered.

Who Should Consider ACCESS?

ACCESS is a strong fit for organizations that:

✅ Already deliver tech-enabled chronic care (diabetes programs, virtual MSK, behavioral health, etc.)

✅ Have an outcomes-focused care model (not just billing for activities)

✅ Want to expand into Medicare fee-for-service (beyond just Medicare Advantage)

✅ Can designate a physician Clinical Director

✅ Have (or can build) infrastructure for outcomes tracking and data sharing

If that sounds like you, ACCESS could be a game-changer. And if you're a Healthie customer, you're already on a platform designed for this moment.

What's Next?

We'll keep updating this guide as CMS releases the Request for Applications, technical specifications, and payment details. There's still a lot we don't know - like exact payment amounts per track and specific reporting requirements - but we'll break it down as soon as the information is available.

In the meantime, here's what you can do:

1. Review your current capabilities - Can you track outcomes? Share data with other providers? Capture patient-reported measures?
2. Consider Medicare Part B enrollment - If you're not already enrolled, you'll need to be (or partner with an organization that is). This process takes time.
3. Talk to your Healthie team - We're here to help you think through how your Healthie setup can support ACCESS participation.

Learn More

📄 CMS ACCESS Model Overview

📄 CMS ACCESS Technical FAQs

Have questions about how Healthie can support your ACCESS preparation? Reach out to our team - we'd love to help you navigate this exciting opportunity.

About Healthie: Healthie powers healthcare outside the hospital. Our EHR, telehealth, and patient engagement platform supports over 40,000 clinicians delivering longitudinal, collaborative care to 15+ million patient lives. From behavioral health to nutrition to chronic disease management, Healthie is the infrastructure for tech-enabled care at scale.

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