CMS ACCESS Model for ACOs: Patient Stratification, Value-Based Care, and RPM

CMS ACCESS Model Summary

• What it is: A voluntary CMS Innovation Center payment model that pays care organizations for chronic care outcomes rather than service volume.
• Timeline: Launched July 5, 2026, and running through June 30, 2036, with applications accepted on a rolling basis until April 1, 2033.
• Who can participate: Any organization enrolled in Medicare Part B as a provider or supplier, except durable medical equipment and laboratory suppliers.
• How the payment model works: Outcome-Aligned Payments across four clinical tracks, with 50% of each payment withheld until CMS verifies that outcome targets were met.
• Why ACOs care: Beginning in 2028, ACCESS spending counts toward ACO benchmarks without raising them.

What Is the CMS ACCESS Model and How Its Payment Model Works

The CMS ACCESS Model is a voluntary payment model that reimburses care organizations based on whether Medicare patients get healthier, rather than on the volume of services (such as a visit, a device, or a monthly monitoring code) they deliver.

ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. It launched on July 5, 2026, and the CMS Innovation Center will run it for 10 years, through June 30, 2036.

If you lead an ACO, the model matters to you in two ways. Your aligned patients can now enroll with ACCESS organizations, and starting in 2028, those payments will be factored into your benchmark calculations.

ACCESS Model payments are made through the Outcome-Aligned Payment (OAP) system. It’s a recurring payment for managing a patient's qualifying condition over a 12-month care period.

Full payment depends on whether the patient's clinical status has improved. For example, whether a patient with severe hypertension lowers their systolic blood pressure from 240 mm Hg to 190 mm Hg over the course of the year.

The model operates on a few core principles:

• Participation is voluntary: No organization or patient is assigned to the model. You choose whether to join, and beneficiaries choose whether to enroll.
• Half of each payment is withheld and tied to results: Participants (the organization) are paid monthly, but CMS withholds 50% of each payment for a year. It releases the withheld amount only after reviewing whether your patients met their outcome targets.
• The listed payment amounts include patient cost-sharing: Medicare covers 80% of each Outcome-Aligned Payment, and the patient is responsible for the remaining 20% coinsurance.

CMS organized the model into 4 clinical tracks. A track is a grouping of related chronic conditions that are managed in similar ways, each with its own payment rate and outcome targets.

Within each track, a patient's first year is the initial period, and each subsequent year is the follow-on period.

Those figures come from the CMS payment guidance covering July 5, 2026, through December 31, 2027.

Why the CMS ACCESS Model Matters for ACOs

For ACOs, the central concern is finance. Beginning in 2028, ACCESS spending will count toward your benchmark, but enrolling a patient in ACCESS does not raise that benchmark.

In other words, when your patients enroll with an ACCESS organization on their own, the resulting payments are added to your total spending and measured against the same target. That reduces the shared savings you would otherwise earn.

Consider an example. Suppose 2,000 of your aligned patients enroll independently. At $420 each, that adds $840,000 to your total spending, measured against your existing target. Your calculated savings shrink accordingly, and so does your share.

Timing offers some relief, though. CMS keeps ACCESS payments out of your spending target for 2026 and 2027, so those two years carry no benchmark impact. That changes in 2028, when ACCESS spending begins counting against ACO benchmarks.

That leaves roughly 18 months to decide whether you will direct these patients or let them enroll wherever they choose. You have two ways to guide them:

• A public directory: CMS will publish a list of every ACCESS organization, along with how well its patients performed. Review those outcomes before referring anyone.
• A $30 co-management payment for staying involved: When your physician reviews an ACCESS update, adjusts a medication, and bills Medicare, they receive a $30 payment. They can do this three times a year per patient, plus a one-time $10 setup fee, without formally joining the model.

The pressure will not stop at Medicare. Private payers covering 165 million members have agreed to adopt the ACCESS payment approach.

Patient Stratification for the ACCESS Model

Stratification means sorting patients by clinical severity. Most ACOs do this once a year in a spreadsheet. ACCESS does it the moment a patient enrolls, using measured values instead of chart review.

How ACCESS Classifies a Patient at Enrollment

Every patient needs a baseline measurement within 60 days of enrollment. For eCKM and CKM, that means blood pressure and weight or BMI for everyone, plus HbA1c for prediabetes or diabetes, and LDL-C for dyslipidemia.

This baseline sorts each patient into one of two tiers:

• Initial Period (higher rate): The patient has not been treated in this track in the past two years, and at least one measure is off target. These patients need more clinical effort.
• Follow-On Period (lower rate, about half the Initial Period amount): The patient is already established in care, and their measures are already on target.

The same baseline also sets each patient's individual goal. No two patients necessarily share the same target. A patient starting at 160 systolic needs to reach 145 to earn payment.

The physician may still want that patient below 130 over the long term, but 145 is the threshold that earns payment for the year. CMS designed the model this way so that participating organizations have no incentive to turn away their sickest patients.

Outcome Attainment and the Withheld Payment

CMS pays monthly, but caps it at 50% of the annual amount. The rest is withheld until after the 12-month period, when CMS checks two thresholds:

• At least 50% of your patients meet their goals: Every required measurement for a patient's track must land within the target, and anything short of that counts as a failing result for that patient.
• At least 90% of your patients avoid duplicate care: No other provider may bill Medicare for treating the same condition you are managing.

There is an important implication here. A patient who stops responding to outreach still counts against your results.

Keeping patients engaged is now a direct payment concern, which is why RPM for chronic disease management should be part of your enrollment plan from the outset.

Population Health Strategy With the CMS ACCESS Model

Engagement produces the numbers. Reporting those numbers to CMS is a separate obligation, and it runs on a fixed schedule:

• Baseline: Submit it within 60 days of the patient signing up.
• Quarterly: Submit an update 70 to 110 days after the previous one.
• End of period: Submit it by day 425.

Care updates must also reach each patient's primary care provider through a health information exchange or similar trusted network.

A login portal on your own website does not satisfy this requirement unless the receiving clinician already has a data-sharing relationship with you.

On access to care, CMS drew two clear lines:

• You cannot sell patients devices: As the ACCESS Participant, you can give patients a device or loan them one. Patients can also bring their own. But you cannot make a patient buy a device (or make that a condition of enrolling your patient), so plan your care pathway around free or loaned devices.
• Rural patients incur a $15 add-on: Shipping and supporting a connected device cost more in rural areas, so CMS pays an additional $15 for the two metabolic tracks (eCKM and CKM).

That combination favors organizations with genuine device logistics. If you are evaluating support for accountable care organizations, ask how their devices are shipped, activated, and replaced.

Connection Between Digital Health, the CMS ACCESS Model, and Remote Patient Monitoring

You might assume ACCESS is simply a new billing opportunity for your RPM program. This is where many explainers get it wrong, so it is worth clarifying.

ACCESS is not a new way to bill for remote patient monitoring. Once a patient enrolls with you under ACCESS, you can only bill the ACCESS codes for that patient's care during the year. Your usual RPM billing codes no longer apply for that patient, and neither do your chronic care management codes.

So why invest in monitoring at all? Because monitoring produces the measurements that determine whether you get paid.

CMS made this assumption explicit. In its Request for Applications guide, CMS explains that the payment rates for the two metabolic tracks already include the cost of a cellular blood pressure cuff.

The device is built into the price, and CMS expects organizations to provide one to patients or otherwise ensure that the patients have one.

However, hardware alone does not move outcomes. A 2017 individual patient data meta-analysis in PLOS Medicine pooled 25 trials and found:

• With self-monitoring alone, patients' systolic blood pressure fell only 1.0 mmHg, which was not statistically significant.
• With self-monitoring paired with intensive clinical support, systolic blood pressure fell 6.1 mmHg.

Clinical support is what drives the number. Someone has to review the readings, contact the patient, and inform the physician of what changed.

That is the case for pairing a monitoring program with chronic care management and principal care management workflows, even when the billing runs through ACCESS G-codes.

What Technology and Tools ACOs Need to Participate in the ACCESS Model

Participation is as much an operational question as a clinical one. CMS maintains an ACCESS Tools Directory of technologies and vendors that participants can use, but the directory lists options rather than certifying them, so the diligence still sits with you.

Before you apply or start referring patients, confirm your organization can cover four capabilities:

1. Measurement capture: Connected devices that produce a verifiable blood pressure, weight, or glucose reading from the patient's home, on the schedule the model requires.
2. Remote patient monitoring workflow: Staff who review incoming readings, escalate out-of-range values, and document the contact.
3. Chronic care management and principal care management capacity: The care-coordination work that actually moves a measure toward target, even though billing runs through ACCESS codes rather than CCM or PCM codes.
4. Reporting and data exchange: Baseline, quarterly, and end-of-period submissions to CMS, plus care updates delivered to the patient's primary care provider over a health information exchange.

An organization missing any one of the four can still participate, but it will be buying that capability from a partner. That decision is easier to make before the enrollment window opens than after outcomes are already being measured.

How KangarooHealth Supports the CMS ACCESS Model

KangarooHealth has run remote monitoring programs for ACOs and care organizations since 2015, years before RPM reimbursement became mainstream. We support ACOs and care organizations participating in the ACCESS Model by giving their care teams the monitoring capacity that outcome-based payment demands.

Every ACCESS requirement that turns on data — the baseline measurement within 60 days, the quarterly submissions, the 50% outcome-attainment threshold, device provision without asking the patient to buy anything — depends on monitoring that runs reliably in the patient's home. That is the part we operate.

Here is what that looks like in practice:

• Devices: We procure and ship connected devices, which matters when you cannot require patients to buy them.
• Clinical monitoring: Our multilingual nurses provide white-label monitoring, following the care plans your providers set. Coaching is ongoing and consistent, delivered on a regular schedule.
• In-house option: You can continue internal monitoring and use our devices and platform while your own staff reviews the data.
• Reporting: We track time and generate reimbursement reports. Billing runs through third-party partners, and we can help you establish that relationship.
• Integration: Custom integration connects our platform to your EMR.
• Support hours: Our support runs during clinic and hospital operating hours.

We have collected more than 6 million physiological data points across over 200,000 monitoring hours and supported more than 13,500 lives through our remote patient monitoring program.

Across our own program reporting, client care teams have seen a 48% reduction in adverse events, and our client satisfaction rate is 98%.

Setup and implementation take less than 2 weeks. Seeing meaningful program results, however, typically takes 2 to 3 months, because enrollment ramps gradually and referrals build over time.

Schedule your demo today and begin offering your own connected care programs to your patients.

Frequently Asked Questions (FAQs)

Below are a few common questions about the ACCESS Model:

Who Are the CMS ACCESS Model Participants?

Any organization enrolled in Medicare Part B as a provider or supplier can participate in the ACCESS Model, with the exception of durable medical equipment and laboratory suppliers.

You also need an active Taxpayer Identification Number, state licensure, HIPAA and FDA compliance, and a physician Clinical Director. CMS accepts applications on a rolling basis through April 1, 2033.

How Much Does the CMS ACCESS Model Pay?

Outcome-Aligned Payments range from $180 to $420 per patient for an initial period, depending on the clinical track, with follow-on periods paying roughly half.

Medicare covers 80%, and the patient owes 20% coinsurance; CMS withholds 50% of each payment until outcomes are verified, and the two metabolic tracks earn an additional $15 for rural patients.

When Did the CMS ACCESS Model Start and How Long Does It Run?

The model launched on July 5, 2026, and the CMS Innovation Center will run it for 10 years, through June 30, 2036.

Applications are accepted on a rolling basis through April 1, 2033, and ACCESS spending begins counting toward ACO benchmarks in 2028.

Is the ACCESS Model Mandatory for ACOs?

No. ACCESS is voluntary for organizations and for patients alike. Your ACO does not have to join, refer, or change anything at this stage.

The 2028 benchmark inclusion takes effect either way.

What Is the Difference Between the ACCESS Model and the CGT Access Model?

The two models share a name and little else. ACCESS pays Medicare organizations for chronic condition outcomes across four clinical tracks.

The Cell and Gene Therapy (CGT) Access Model helps state Medicaid programs afford gene therapy for sickle cell disease, using outcomes-based agreements that CMS negotiates with manufacturers. 33 states, plus the District of Columbia and Puerto Rico, have signed on, covering roughly 84% of Medicaid beneficiaries with the condition.

Do Medicare Beneficiaries Pay to Enroll in the ACCESS Model?

No. Medicare beneficiaries pay nothing to enroll in the ACCESS Model, and their benefits stay the same.

Patients owe the standard 20% coinsurance on Outcome-Aligned Payments, though organizations may waive it.

Can ACOs Use Remote Patient Monitoring Under the CMS ACCESS Model?

Yes, but not as a separate billing line. Once a patient is enrolled in ACCESS, you bill the ACCESS codes rather than your usual RPM codes, so monitoring becomes the operational engine behind outcome attainment rather than a revenue stream of its own.

Most organizations still run a full remote patient monitoring program under ACCESS, because the baseline, quarterly, and end-of-period measurements the model requires have to come from somewhere.

Conclusion

ACCESS pays you when patients reach their targets. Getting there, however, requires a verified reading from a patient's home, on schedule, and someone who acts on it. Managing that alone is a considerable undertaking for ACOs and other care organizations.

KangarooHealth was founded in 2015 by Dr. Kang, a physician-researcher who completed her PhD and medical training at Johns Hopkins University, specifically to solve this problem. A decade later, hundreds of providers nationwide use the platform to run connected care programs, and that operating history is what informs the ACCESS workflow described above.

Our cellular, senior-friendly devices work without home Wi-Fi. Our multilingual nurses keep patients engaged, and we report a 92% patient compliance rate. Platform, devices, and clinical staff all come from a single contract.

Want to see how it performs against your own panel? Schedule a demo with us, and we will walk through your highest-risk patients together.