The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model is a voluntary Original Medicare model that expands access to clinician-guided, technology-supported care for common chronic conditions. GamePlan Medical helps patients turn care plans into daily action through physician oversight, trained care navigators, secure digital tools, and trusted community partners.
ACCESS is a 10-year CMS Innovation Center model beginning in 2026. It tests Outcome-Aligned Payments for integrated, technology-supported care in Original Medicare—rewarding measurable improvement rather than the volume of services delivered.
GamePlan Medical provides clinician-guided care navigation between traditional visits. Our teams support lifestyle change, medication routines, education, care coordination, and secure progress tracking while keeping primary care and referring clinicians informed. Patients keep their Medicare rights and may continue seeing any Medicare provider.
Support tailored to each patient’s starting point, health goals, daily routines, and qualifying conditions.
Care focused on measurable improvement in blood pressure, A1c, lipids, weight, pain, mood, and function.
Technology-supported care organized around results, accountability, and continuous progress—not visit volume.
Trusted local touchpoints, including community pharmacies, help make support accessible and practical.
Secure digital tools and regular check-ins help monitor progress, identify barriers, and guide next steps.
Primary care and referring clinicians remain central and can receive electronic updates on patient progress.
GamePlan Medical can help determine whether ACCESS may fit your needs. Participation is voluntary and is designed for people with Original Medicare who have qualifying conditions in an ACCESS clinical track. Final eligibility and enrollment depend on CMS requirements and the participating care organization.
Traditional fee-for-service payments are tied to specific activities or devices. ACCESS introduces Outcome-Aligned Payments (OAPs) — a recurring payment for managing a patient’s qualifying condition, with payment tied to achieving measurable health outcomes. This approach rewards results, not activities, and enables flexible, technology-supported care that improves patients’ health.
No. Participating in ACCESS does not change Medicare benefits, coverage, or rights. Patients keep all standard Medicare protections and can continue to see any Medicare provider. Some ACCESS organizations may waive standard Medicare cost-sharing, but participation is always voluntary.
ACCESS embeds strong safeguards to support clinical quality and accountability. Organizations must enroll in Medicare Part B as providers or suppliers and designate a physician Clinical Director to oversee clinical quality and compliance. All participating organizations must comply with all applicable federal and state regulations — including licensure requirements and HIPAA and FDA requirements (or otherwise be subject to FDA enforcement discretion). CMS will monitor performance and may terminate organizations who fail to meet quality, safety, or outcome standards. To promote transparency, CMS will publish risk-adjusted outcomes in a public directory.
ACCESS participants must comply with all Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security requirements as covered entities. CMS complies with HIPAA and other applicable federal laws to protect Medicare beneficiary information and has strict policies regarding use of that information for care coordination, reporting, and evaluation.
ACCESS participants will use secure, interoperable systems—including CMS APIs for eligibility, enrollment, and reporting—to sign up patients, share clinical data, track outcomes, and coordinate care with beneficiaries’ primary and referring clinicians.
Each clinical track includes a set of guideline-informed, condition-specific measures and outcome targets. CMS determines payment based on the overall share of patients who meet their defined outcomes, compared to a minimum threshold that increases with each participation year. This balances accountability with accessibility and rewards strong overall performance.
ACCESS is designed to integrate with traditional care. Primary care and referring clinicians can refer patients to participating organizations, receive electronic updates from ACCESS organizations on their patients’ progress, and bill a new co-management payment for documented review and coordination activities.
ACCESS complements ACO and other risk-bearing arrangements by empowering risk-bearing entities with new care options to support their patients with chronic conditions and meet quality and savings goals.
For 2026 and 2027, CMS will be making system changes to support model operations, and CMS anticipates that there will be no impact from ACCESS OAPs on ACO benchmark and performance year calculations for the Medicare Shared Savings Program and ACO REACH. Beginning in 2028, expenditures associated with ACCESS OAPs will be included in ACO benchmark and performance year calculations.
Risk-bearing entities may refer their aligned beneficiaries to ACCESS participants—who are all Medicare Part B-enrolled providers or suppliers— and should consider applicable legal requirements including compliance with the Anti-Kickback Statute and Physician Self-Referral Law. CMS will maintain a public directory of ACCESS participants, the conditions they treat, and their risk-adjusted outcomes to help ACOs make informed referral decisions.
ACCESS provides an outcome-aligned payment option that replaces traditional fee-for-service billing for ACCESS Participants for beneficiaries for whom the Participant bills ACCESS codes. To preserve model integrity and prevent duplicative Medicare payments, ACCESS Participants and their affiliated entities may not submit Medicare Fee-For-Service (FFS) claims (directly, or indirectly through another organization for which they provide contracted services) for other services furnished to their ACCESS-aligned beneficiaries during an active care period. Only ACCESS G-codes may be billed for aligned beneficiaries during active care periods. See the Request for Applications for more information.
Overall, ACCESS expands the set of options available to ACOs. For example, a primary care organization participating in an ACO may support its patients with chronic conditions by coordinating care with ACCESS participants serving its geography and billing ACCESS co-management codes for documented review of patient updates. If that primary care organization also offers its own technology-enabled chronic care program, such as a virtual musculoskeletal program, it may choose to also join ACCESS as a participant to expand its reach. As an ACCESS Participant, the organization could offer ACCESS services (billed using ACCESS G-codes) to beneficiaries who are not aligned to its ACO, while continuing to bill traditional Medicare FFS claims for its ACO-aligned beneficiaries who are not enrolled in ACCESS.
ACCESS is being tested in Original Medicare, but Medicare Advantage (MA) organizations may independently adopt similar outcome-aligned payment arrangements with their contracted providers.
