News 12/3/25

Top News A new, 10-year CMS model called ACCESS will test whether an outcome-aligned payment approach can expand

access to technology-enabled chronic care management in Original Medicare starting in…

In-Depth Context

and Historical Background

In-Depth Context

and Historical Background

The introduction of the ACCESS model by the Centers for Medicare and Medicaid Services marks not merely an incremental policy shift but a strategic culmination of over a decade of federally mandated payment reform efforts. To fully appreciate the scope and political gravity of this 10-year demonstration project, one must place it squarely within the historical trajectory of the Center for Medicare and Medicaid Innovation (CMMI), established under the Affordable Care Act (ACA) in 2010. CMMI’s original statutory mandate was to test payment and service delivery models that reduce expenditures while maintaining or improving quality. ACCESS represents the Innovation Center’s most explicit attempt yet to merge the hard-learned lessons of value-based care with the seismic shift in healthcare delivery driven by technological maturity and post-pandemic regulatory acceptance.

Early CMMI models, such as the Pioneer Accountable Care Organizations (ACOs) and the Bundled Payments for Care Improvement (BPCI) initiative, focused primarily on structural changes—encouraging provider collaboration and episode-based savings. While these models successfully proved that fee-for-service (FFS) inertia could be challenged, they often struggled with provider exhaustion due to complexity, rapid rule changes, and insufficient time frames (often five years or less) to stabilize clinical behavior and demonstrate true budget neutrality. ACCESS addresses these criticisms directly by offering an unprecedented 10-year horizon, signaling administrative stability crucial for health systems making substantial capital investments in new technology infrastructure and staff training necessary for sophisticated chronic care management (CCM).

The focus on “technology-enabled chronic care management” is particularly telling. For years prior to 2020, regulatory bodies were deeply skeptical of leveraging remote patient monitoring (RPM) and general telehealth for standard Original Medicare beneficiaries, citing concerns over fraud, abuse, and the quality of asynchronous care. The public health emergency forced an immediate, temporary lifting of these restrictions, providing real-world proof-of-concept for the efficacy of virtual care in maintaining compliance and reducing acute events for patients with complex conditions like diabetes, COPD, and hypertension. ACCESS effectively formalizes this regulatory shift, making the utilization of RPM and digital therapeutic platforms a cornerstone of the required service delivery, rather than an optional add-on. This makes the model less about provider structure and more about optimizing the patient-provider interaction through continuous data streams.

Furthermore, implementing a high-stakes, technology-heavy model specifically within Original Medicare—the traditional FFS system—is politically and fiscally ambitious. Original Medicare presents distinct challenges compared to Medicare Advantage (MA) plans, where vertically integrated organizations already manage risk and incentivize technology adoption through capitated payments. FFS providers, however, rely on volume. Overcoming this FFS resistance requires a payment model—the outcome-aligned approach utilized in ACCESS—that offers financial incentives large enough to justify the necessary investment and change management. If ACCESS succeeds in demonstrating significant outcome improvements (e.g., reductions in hospital readmissions or emergency department visits) that translate into net savings within the FFS environment, it provides an unassailable data point for future expansion across the entire Medicare population.

The political dimension of a 10-year model cannot be overstated. By spanning potentially three different presidential administrations, ACCESS is designed to transcend the volatile short-term political cycles that often doom shorter demonstration projects. Congressional interest in Medicare solvency and the rising costs of chronic disease management ensures intense oversight, particularly from the House Ways and Means and Senate Finance Committees. Successful execution of ACCESS would provide political cover for policymakers across the aisle, allowing them to claim success in modernizing Medicare while theoretically bending the cost curve. Conversely, failure would significantly bolster arguments made by those who advocate for accelerating the migration of beneficiaries entirely into private MA structures, positioning ACCESS as perhaps the final, defining test of whether centralized government innovation can successfully shepherd the FFS structure into the digital age of healthcare delivery.

Comprehensive Analysis

of Key Stakeholders

Comprehensive Analysis

of Key Stakeholders

The ACCESS model, designed as a decadal framework for transforming chronic care payment, establishes a complex web of interconnected stakeholders whose alignment, or lack thereof, will determine the model’s ultimate success and scalability. This is not merely a technical adjustment to payment codes; it represents a significant political and economic redistribution of risk and opportunity across the healthcare ecosystem. AegisPolitica’s analysis identifies five primary stakeholder groups, each facing unique pressures under the outcome-aligned structure.

The Centers for Medicare and Medicaid Services, specifically the Center for Medicare and Medicaid Innovation (CMMI), function as the primary architects and central risk-holders of the initiative. Their immediate interest is to generate robust, replicable data demonstrating that technology-enabled value-based care (VBC) can achieve significant savings while improving clinical outcomes—the mandate established during CMMI’s initial authorization. Failure to prove significant fiscal benefit over the initial five-year assessment period risks political scrutiny and potential defunding or redirection. CMMI’s leverage lies in its control over access to Original Medicare patient populations and its ability to refine the risk adjustment methodologies, effectively controlling the economic viability for participating providers. The strategic objective for CMS is to institutionalize this VBC methodology, making the transition back to fee-for-service (FFS) chronic care politically and logistically impractical by 2035.

Healthcare providers, encompassing large Integrated Delivery Networks (IDNs) and independent Primary Care Physician (PCP) groups, represent the crucial operational stakeholders. Their participation is optional but essential for the model’s scale. For sophisticated IDNs already investing in population health infrastructure, ACCESS offers a guaranteed mechanism to monetize those investments within the high-value Medicare demographic. However, smaller physician practices face steep barriers to entry, including substantial upfront capital expenditure for compatible technology platforms and the requisite staffing—such as care coordinators and data analysts—to manage outcome risk effectively. The fundamental conflict for providers is reconciling the long-term financial incentive of shared savings with the immediate operational risks associated with migrating away from reliable, volume-based FFS revenue streams. Provider buy-in hinges on CMMI’s ability to minimize administrative friction and provide risk corridors robust enough to prevent catastrophic financial losses during the learning curve.

The third critical stakeholder group comprises Medicare beneficiaries, the recipients of the technological intervention. While the promise of ACCESS is enhanced chronic care management and greater convenience, the primary risk involves exacerbating health equity issues and the digital divide. A significant portion of the Original Medicare population faces challenges related to technology literacy, reliable broadband access, or limitations imposed by chronic conditions (e.g., dexterity issues with devices). Advocacy groups, such as AARP and disease-specific patient associations, hold significant leverage in monitoring the model’s impact on access, ensuring that technology serves as a bridge, not a barrier, to high-quality care. If data indicates that ACCESS participation correlates with socioeconomic status or geographical location, CMS will face intense political pressure to enforce equity standards or redesign required technological delivery methods.

Technology vendors, ranging from established electronic health record (EHR) companies to agile chronic care management platforms, are positioned as the critical enablers and financiers of the ACCESS infrastructure. Their interest is purely commercial—to establish their proprietary technology as the industry standard validated by federal approval and subsidized through new CMS payment mechanisms. ACCESS effectively opens a guaranteed, decade-long procurement pipeline into the lucrative Medicare market. Their leverage is derived from owning the proprietary tools (remote monitoring, AI-driven risk stratification, virtual care platforms) that providers need to meet outcome requirements. This creates a highly competitive environment where compliance, data security, and seamless integration capabilities become decisive competitive factors. Analysts project a significant consolidation trend among smaller health tech firms unable to handle the stringent CMMI compliance load, further empowering large-scale platform providers.

Finally, Congressional Oversight Committees, particularly those focused on the Medicare Trust Fund and appropriations, hold significant political leverage. Since ACCESS is a 10-year model, it is designed to span multiple legislative cycles, requiring sustained political commitment. Lawmakers are primarily focused on the actuarial soundness of the model. Positive reports regarding savings will bolster support, while reports of increased expenditure or beneficiary complaints could trigger immediate committee investigations and attempts to curb CMMI’s discretionary authority. Advocacy and watchdog groups, such as the Medicare Payment Advisory Commission (MedPAC), serve as key influencers, providing objective, non-partisan assessments that often form the basis of legislative action. The long-term success of ACCESS, therefore, depends less on initial provider uptake and more on achieving political resilience and demonstrating fiscal responsibility consistently across two presidential administrations.

Global Impact Assessment

Global Impact Assessment

The introduction of the ACCESS model by the Centers for Medicare and Medicaid Services (CMS), while fundamentally a domestic policy overhaul, carries significant unavoidable international externalities. The sheer scale of the U.S. healthcare market—representing nearly half of global biomedical research and development spending and acting as the primary anchor for multinational MedTech and pharmaceutical firm valuations—means any structural payment reform initiates immediate ripples across global regulatory, financial, and competitive landscapes. AegisPolitica assesses these impacts across three primary dimensions: technology standards diffusion, international market pricing pressure, and the geopolitical projection of efficiency models.

Technology Standards and Market Harmonization

ACCESS specifically targets technology-enabled chronic care management, signaling a powerful U.S. commitment to integrating digital health solutions, remote monitoring, and artificial intelligence diagnostics into core payment structures. This creates an enormous, centralized demand signal for multinational MedTech companies, many headquartered in Europe, Israel, and Japan. Success within the ACCESS framework will rapidly become the de facto global quality benchmark for digital therapeutics and chronic care AI tools. Firms seeking market entry or expansion in the lucrative U.S. elderly care segment must align their product development and validation processes to meet the outcome-aligned metrics established by ACCESS.

The downstream regulatory effect is profound. Non-U.S. health authorities, particularly the European Medicines Agency (EMA) and similar bodies in high-income OECD nations, will face heightened pressure to accelerate their own assessment methodologies for digital health solutions. If the U.S. establishes a comprehensive framework for generating Real-World Evidence (RWE) to validate digital chronic care effectiveness over a 10-year horizon, international bodies risk regulatory fragmentation or, worse, becoming laggards in adopting proven, cost-saving technologies. This drives a powerful, market-led push toward global standardization of digital health efficacy data, inadvertently strengthening the U.S. regulatory paradigm as the international norm.

Pricing Dynamics and R&D Investment

The ACCESS model’s focus on controlling the total cost of care for chronic conditions implicitly sharpens scrutiny on high-cost interventions, including specialty pharmaceuticals and complex devices. While ACCESS does not directly regulate drug prices, its success hinges on shifting incentives toward holistic, efficient management rather than fee-for-service treatments. If the model effectively reduces the overall burden of chronic disease through technological efficiencies, it inherently limits the pricing power of therapies whose benefit-cost ratio falls short of the newly optimized baseline.

This domestic efficiency gain reverberates internationally. Healthcare systems that rely on the U.S. market to fund global R&D—an arrangement often criticized as international ‘free riding’—will leverage the operational metrics established by ACCESS to strengthen their own negotiating positions with pharmaceutical manufacturers. National health services (like the U.K.’s NHS or Canada’s provincial systems) will demand justification for specialty drug pricing based not merely on clinical trial data, but on demonstrated efficacy within integrated, outcome-aligned systems akin to ACCESS. This could marginally dampen global expectations for R&D returns focused solely on incremental drug development, encouraging a shift toward innovations that facilitate efficient chronic care delivery and maintenance.

Geopolitical Projection and Soft Power

The long-term success or failure of ACCESS carries geopolitical weight regarding U.S. administrative capacity. For decades, the U.S. has projected unrivaled leadership in medical innovation, but often lags peer nations in delivery efficiency and universal access. ACCESS represents a major, centralized effort to solve the delivery challenge for the most expensive segment of the population.

A successful ACCESS implementation—demonstrating sustained cost control alongside improved patient outcomes via advanced technology—would reinforce U.S. soft power, showcasing its capability to govern complex, data-intensive healthcare reforms. It positions the U.S. not just as the source of medical breakthroughs, but as the architect of efficient, modern delivery systems, an image crucial in the global competition with alternative models, particularly China’s state-controlled digital health infrastructure. Conversely, failure—defined by massive cost overruns, poor data security, or insufficient provider uptake—would serve as cautionary evidence for other nations that the U.S. model remains structurally fragmented, lending credence to centralized or single-payer alternatives studied closely in the developing world and emerging economies. The commitment of a decade-long timeline signals seriousness, making ACCESS a core diplomatic talking point in multilateral health forums concerning sustainable healthcare financing.

Counter-Arguments and Public Response

Counter-Arguments and Public Response

The announcement of the ACCESS model, while generating immediate enthusiasm within the digital health vendor community, has been met with significant skepticism across several critical political and operational sectors. The 10-year commitment and the ambitious scope of technology integration have catalyzed distinct lines of counter-argument from fiscal conservatives, traditional provider organizations, and patient advocacy groups concerned about equitable implementation.

Congressional Republicans, specifically those on the House Ways and Means and Senate Finance Committees, immediately voiced opposition centered on the unprecedented length and potential costs of the model. Representative Eliza Vance (R-TX), a ranking member of the Ways and Means Health Subcommittee, issued a statement labeling ACCESS an “unfunded federal obligation masquerading as innovation.” The primary critique targets the ten-year duration, arguing it locks the federal government into an experimental program long after market dynamics or clinical evidence might suggest alternative approaches. Critics contend that the commitment limits CMS’s ability to pivot or cancel the project should initial performance indicators prove insufficient or if the technology rapidly becomes obsolete. Furthermore, there is deep suspicion that the administrative complexity inherent in aligning outcome metrics across millions of beneficiaries over a decade will lead to significant bureaucratic overhead and fraud potential, dwarfing the purported long-term savings in chronic care management. They demand immediate transparency regarding the cost-benefit analysis and the methodology used to project the model’s ultimate fiscal neutrality.

Skepticism from the provider community is equally pronounced, though focused less on fiscal policy and more on operational risk. The American Medical Association (AMA) and several large integrated delivery networks (IDNs) have publicly expressed concern over the “outcome-aligned payment” structure. While supporting the concept of technology-enabled care, providers fear that the outcome alignment unfairly shifts financial risk onto practices, especially small or rural clinics, for factors outside their control, specifically related to the social determinants of health. If a patient lacks stable housing, adequate nutrition, or reliable broadband access—issues that directly impact chronic disease outcomes—the provider faces penalties under ACCESS despite having deployed the required technology and best clinical practices. Rural health organizations, in particular, cite substantial upfront investment required for compliant telehealth platforms, remote monitoring devices, and dedicated IT infrastructure, costs that may not be recouped quickly, especially in areas with low patient density or poor connectivity. These groups are pushing CMS to incorporate robust, regionally tailored risk adjustments that account for infrastructure deficits and socioeconomic barriers before the model is fully deployed.

Public response from patient advocacy organizations has centered almost entirely on the potential for exacerbating the digital divide. Groups like AARP and various consumer protection agencies have voiced strong reservations regarding the mandated reliance on technology. For Medicare beneficiaries, particularly those over 75 or those in low-income brackets, access to and literacy regarding sophisticated technology (like continuous glucose monitors transmitting real-time data or required teleconferencing platforms) is not universal. Advocates worry that the ACCESS model will effectively create a tiered system of care: high-tech, proactive chronic care management for digitally fluent beneficiaries, and lower-level, traditional care for those unable or unwilling to participate in the technology ecosystem. They call for explicit CMS provisions requiring participating practices to offer equally high-quality, non-technologically dependent alternatives, ensuring the model does not become a soft mechanism for denying enhanced services to the most vulnerable populations. Data privacy is a secondary, but serious, concern; the volume of real-time health data captured by ACCESS requires explicit guarantees regarding security and protection from third-party vendor exploitation, a necessary safeguard given the 10-year lifespan of the program.

Conversely, the reaction from the venture capital and digital health industry has been overwhelmingly positive, describing the announcement as the single largest federal market signal since the HITECH Act. This cohort views ACCESS as validation of their long-standing investment thesis—that technology integration is essential for managing the growing chronic disease burden. Stock prices for key players specializing in remote patient monitoring, chronic care software, and data analytics saw immediate upticks following the leak and official release of the model details. They see the 10-year span not as a risk, but as predictable regulatory certainty necessary to justify massive scaling operations. This industry cheerleading, however, fuels the fears of critics who worry the model’s design overly favors large, politically connected technology firms capable of navigating the complex regulatory reporting requirements imposed by CMS. AegisPolitica analysts anticipate significant lobbying activity throughout 2026 as these technology entities jockey for preferred vendor status within the new chronic care ecosystem.

CMS has attempted to preempt these criticisms by highlighting the model’s phased implementation, promising robust data collection on socioeconomic disparities and offering infrastructure grants aimed at mitigating the digital divide in high-need areas. However, these reassurances have done little to quell the political and operational turbulence, positioning ACCESS as a major focal point for upcoming healthcare oversight hearings.