3 Key Takeaways from the ACCESS Model Kickoff Call

As part of the Centers for Medicare and Medicaid Services (CMS) efforts to push toward more accountable, outcomes-driven care models, they are launching a new model in July that is one of the most compelling and potentially impactful in recent years. Many leading medical societies have expressed their support for the model, with multiple major commercial health plans offering aligned payment options for technology-supported care.

What makes ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) so different? Cedar Gate’s Medical Advisor for Clinical Solutions, Dr. Joseph Siemienczuk and our other Care Management and CMS experts attended the first kickoff call for the program and shared some key takeaways on the ways this model stands apart from prior value-based care model efforts, and why that presents some exciting opportunities.

1: Physicians are Excited About Opportunity to Impact Outcomes

One of the biggest challenges in the advancement of value-based care over the past two decades has been a reluctance on the part of providers to buy in. That reluctance was understandable in situations where providers were concerned about being held accountable and seeing their reimbursements put at risk for outcomes they didn’t feel like they could control. When providers were responsible for managing care costs and quality metrics across a broad population, including care that took place outside their clinics, and measured against regional or national benchmarks, the odds felt stacked against them.

The ACCESS model focuses on conditions that impact more than two-thirds of Medicare beneficiaries, and that physicians can meaningfully improve within the clinical setting, falling into four tracks:

• eCKM: Early cardio-kidney-metabolic conditions, including hypertension, early dyslipidemia, overweight with markers of obesity, and prediabetes

• CKM: Cardio-kidney-metabolic conditions, including diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease (heart disease)

• MSK: Chronic musculoskeletal pain

• Behavioral Health: Depression and anxiety

Unlike many prior value-based programs, the emphasis is not on managing a broad total cost of care benchmark across an entire patient population. Instead, clinicians are evaluated specifically on how effectively they manage the targeted condition. This design aligns accountability with what physicians actually control inside the practice. Over the course of the performance year, providers can implement treatment plans, monitor progress, and make clinical adjustments that directly affect outcomes.

2: OAPs Change the Financial Picture 

The ACCESS model introduces an innovative payment mechanism called Outcomes Aligned Payments (OAPs). Rather than relying primarily on retrospective reconciliation or shared savings, the model provides a predictable monthly payment tied directly to outcomes. Parameters for payment include:

• Defined performance thresholds tied to the specific clinical track for each OAP, with full payment contingent on achieving measurable improvements in patient health outcomes. 

• Expenses related to managing the chronic condition are withheld in exchange for the OAP.

• OAP targets apply per “care period,” regardless of whether a beneficiary aligns with the same ACCESS-participating provider, or a different one. 

• For each new care period, the goal is for a beneficiary to achieve a clinically meaningful change from baseline, versus a larger annual cost or quality target (as is generally the case with CMS models). 

CMS provides flexibility in how organizations achieve these results. Technology is required to support care management and reporting, but the agency intentionally avoids prescribing specific tools or workflows. The message is clear: organizations have room to innovate, but they are expected to deliver measurable outcomes.

3: An Innovative Approach to Patient Alignment

Another major shift in the ACCESS model is how beneficiaries are aligned with participating organizations. Unlike many CMS value-based programs that rely on retrospective attribution, providers must actively enroll beneficiaries.

When patients are initially enrolled (the “initial period,” defined as the first time treating a beneficiary in the clinical track within the past two years), providers get a higher payment to reflect the cost of implementing the care plan. Once patients are established in the care plan — or are defined by the OAP as being “well-controlled” at the baseline — they enter a follow-on period with a lower reimbursement rate.

Importantly, beneficiaries retain all of their traditional Medicare rights, including freedom of provider choice. Even when patients receive services from other providers, those services may still be considered in the aligned track — and could affect the organization’s OAP performance.

A Model Built Around Outcomes

The ACCESS model signals an evolution in value-based care design. By focusing on clinically manageable conditions, tying payments directly to more definite and patient-centric outcomes, and modernizing patient alignment, CMS is testing a framework that may resonate more strongly with frontline physicians. Many commercial payers are interested in finding innovative ways to reduce costs and improve care — particularly for high-cost chronic conditions — and watching what happens with ACCESS. If and when they identify opportunities to adapt CMS guidelines to improve care for their members, initiatives like ACCESS will likely extend to a larger commercial population.

If early clinician enthusiasm translates into improved outcomes and sustainable participation, the ACCESS model could represent an important step forward in how value-based care programs are structured.