CMS greenlights more than 150 participants for chronic care experiment
Access granted: CMS greenlights more than 150 participants for chronic care experiment
New approach will test whether technology can boost health outcomes, save costs
STAT NEWS
By Mario Aguilar
April 13, 2026
More than 150 companies and providers have been provisionally approved to participate in an experimental Medicare program meant to expand access to technology-supported chronic care. They include popular mental health apps, wearable device makers, a life sciences company tied to Google, and startups that help large health systems manage heart failure patients.
Announced late last year by the Center for Medicare and Medicaid Innovation, the ACCESS model will pay participants set rates to treat chronic conditions like diabetes, hypertension, high cholesterol, musculoskeletal pain, anxiety, and depression. The payments are tied to measurable health outcomes; the model is meant as an alternative to paying for individual technology services. The initial deadline to participate in the first ACCESS cohort was April 1, but CMMI Monday announced it will extend the deadline to allow more to join.
CMS officials say the large number of applications to participate in ACCESS exceeded their expectations and that the enthusiasm suggests modest payment rates and restrictions did not discourage digital health companies from applying. According to officials, most of the participants had not previously served Medicare patients.
Notable participants on the list include mental health tech companies like Headspace, Jimini Health, Limbic, and Slingshot AI. Companies accepted to treat cardiometabolic conditions include Story Health, Cadence, Verily, and Welldoc. Wearable device makers Whoop and Withings were also approved.
Officials have said that 70% of Medicare beneficiaries may be eligible for ACCESS, which helps explain the significant interest. But the large list of approved companies does not mean all will ultimately offer ACCESS services. Many must finish enrolling in Medicare and all must receive final approval from the regulator. Some may decide the program doesn’t meet their business needs.
“Participants will retain the right to determine if the structure of the model works for them and can choose to exit if it does not,” CMS Innovation Center Director Abe Sutton told STAT in a statement. “Given the significant interest shown to date, we are confident in the design of the ACCESS Model.”
The model — whose acronym stands for Advancing Chronic Care with Effective, Scalable Solutions — was initially met with excitement by entrepreneurs and policy experts who believed it could boost the adoption of technology that might improve patients’ health while lowering health care costs. But many were disappointed by the payment rates announced in February as well as some new provisions, like a rule that prohibits participants from billing Medicare for any other services delivered to their ACCESS patients.
The “outcome-aligned payments” range from a maximum of $180 and $420 per patient the first year, depending on the exact condition treated. Participants will only be paid the full amount if at least half of their patients get their conditions under control or improve by a certain degree. For example, patients with hypertension are expected to lower their systolic blood pressure below 130 mm Hg or reduce it by 15 mm Hg. Payments may also be docked if patients seek care for the treated conditions at other providers.
Experts previously told STAT that the payment rates and rules would preclude health systems from participating in ACCESS and that the program favored digital health companies that could make heavy use of artificial intelligence to reduce the reliance on human clinicians and lower costs. Officials, meanwhile, have emphasized that the point of the model was to enable new approaches that use technology to drive efficiency.
The long-term question hanging over the 10-year experiment is whether it can lower Medicare costs while maintaining or improving quality of care. But the issues to watch in the months immediately following the July launch of the first ACCESS cohort are more fundamental, said Will Gordon, a former CMMI official who is now a senior adviser to consultancy Manatt Health.
“Can Medicare beneficiaries be engaged at scale through technology-enabled care?” he asked in an email. “Is there real demand among Medicare’s beneficiaries for these kinds of care models?”
Members of the first cohort have been racing for months to determine whether they would want to participate and then how to apply technology to make it work.
Headspace will make its well-known mental health app available to patients through the ACCESS program but only recently decided on its approach. CEO Tom Pickett said the company originally considered partnering with a Medicare provider that would use Headspace as part of an ACCESS offering. The maximum $180 payment for ACCESS participants targeting behavioral health made that option infeasible, so the company enrolled in Medicare itself.
Headspace will need to do some development work so that it can sign up Medicare patients and record the necessary outcomes, but otherwise the app will resemble what other users experience, including guided meditation and a chatbot that uses techniques like motivational interviewing. Though Headspace has published evidence that the app can help ease anxiety and depression symptoms, the company hasn’t specifically tested the app with people on Medicare.
“It’s very consistent with our strategy of trying to double down on the digital solution and make that as relevant as possible to as many populations as possible,” said Pickett. “We need broader access to mental health tools, and we need to be able to do that at a cost point that makes sense. Frankly, the whole rest of the industry is really stuck in, let’s just drive more therapy mode, which is just becoming prohibitively expensive for the system.”
Direct-to-consumer health apps like Headspace must spend substantial amounts on marketing to acquire users, and Pickett said he’s unsure how much the company will do to promote its ACCESS option. CMS plans to publish a list of approved companies, including their risk-adjusted clinical outcomes, to inform decision-making by patients and their providers.
Digital health company Cadence, meanwhile, has been undertaking a wholesale redesign of its chronic disease programs to use more AI to participate in ACCESS, STAT previously reported. Cadence currently helps hospitals manage their patients with hypertension and other chronic conditions.
The company’s current business model is built around billing for remote patient monitoring codes that require monthly clinician engagement. But CEO Chris Altchek said he believes in the future many of those jobs will be done by artificial intelligence tools, and that the ACCESS program can help the company move forward on that path.
“We don’t really know what the upper limit of patient engagement is going to be,” he said. “You can really only figure out what you have [AI] agents supporting these workflows in a way that it’s very, very challenging to do with human clinicians.”
Because ACCESS doesn’t have a human requirement, Altchek said it’s possible that Cadence can automate enough of the program that a person could potentially only see a clinician once a year. As of early March, Altchek estimated the company had built 25% of the technology needed to participate.
Story Health also helps hospitals manage chronic disease patients and will launch in ACCESS with a focus on treating conditions like hypertension and diabetes. Chief Medical Officer Ashul Govil said the company will rapidly expand to behavioral health and musculoskeletal care for ACCESS, which will be new applications for its technology and services.
Story already makes use of lots of automation to track patients and coordinate care between providers, nurses, coaches, and patients.
“ACCESS has created more of a reason for us to accelerate this effort and to move up some of the clinical management features that were further out on our roadmap,” said Govil. “The need for efficiency also gives us a reason to move up much of the AI development in our platform.”
Even as scores of digital health companies race to participate in ACCESS, others like PursueCare chose to sit it out.
The company is a virtual care provider that specializes in substance use disorder and opioid use disorder treatment and offers software cleared by the Food and Drug Administration for the treatment of these conditions. CEO Nicholas Mercadante said the company already meets many ACCESS requirements but ultimately, decided it couldn’t afford to not bill Medicare for its core services.
“I can appreciate the ambition and talk track over the model but ultimately see a number of policy exclusions that are problematic for us, and likely rate limiters for involvement by others,” he said in an email. “And quite frankly, if there is little or no incentive (and possibly detriment) for a treater to participate, this won’t be a very successful program.”