CMS taps 150 digital health companies, providers for ACCESS Model
CMS taps 150 digital health companies, providers for ACCESS Model.
Fierce Healthcare
By Heather Landi
Apr 13, 2026
The payment rates for the ACCESS model, unveiled in February, were lower than the industry expected and fell below current billing models.
The Centers for Medicare and Medicaid Services picked 150 digital health companies and healthcare providers to participate in the launch of its tech-enabled chronic care model.
The Center for Medicare and Medicaid Innovation (CMMI) announced in December the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model as a 10-year payment program to encourage the use of technology to treat chronic diseases. CMS aims for the ACCESS Model to provide stable, recurring payments for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety. The model will help pay for telehealth software, wearables and wellness apps that address the conditions.
The CMMI plans to use outcome-aligned payments to cover the cost of technology for Medicare providers if a patient with a qualifying chronic condition achieves clinically significant outcomes, such as lowering their blood pressure.
The model will kick off July 5 and run through June 30, 2036.
CMS is also extending the initial application deadline to May 15, the agency said Monday. Applications can be submitted via the participant portal.
Among the 150 organizations selected, most have not previously served Medicare beneficiaries, CMS said in a press release. These organizations "will bring additional technology-supported care options to help people manage chronic conditions like high blood pressure, diabetes, chronic pain and depression," CMS said.
Organizations participating in the ACCESS Model must adhere to strict guardrails, including enrollment in Medicare Part B as providers or suppliers, compliance with licensure, data privacy and security standards, outcome reporting and other quality standards, CMS said.
Commercial payers representing 165 million members across Medicare Advantage, Medicaid and commercial coverage have also agreed to align with the ACCESS Model's payment approach. Payers that signed the pledge include Arkansas Blue Cross and Blue Shield, Blue Shield of California, Blue Cross and Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Centene, Cigna, CVS Health, Devoted Health, Guidewell, Horizon Blue Cross Blue Shield of NJ, Humana and UnitedHealthcare.
These commercial payers agreed to make arrangements with providers that will provide consistent, outcome-aligned payments for the use of healthcare technology. The plans also agreed to work with primary care and referring providers, a hallmark of the CMMI ACCESS model.
The 150 participants selected by CMS to participate include a range of tech-enabled healthcare companies. On the list are AI doctor startup Doctronic, virtual nutrition therapy provider Berry Street, healthy aging startup Bold, mobile health service provider DocGo, remote monitoring company Withings, healthcare navigation app Castlight, virtual medical specialty practice Cecelia Health, virtual mental health company Headspace and Sondermind, a hybrid mental health provider.
Health tech company Verily is among the 150 participants, along with weight-loss companies Noom and Weight Watchers, brain health platform Isaac Health and telehealth provider HealthTap.
Value-based care enablement companies Guidehealth and Aledade were also selected.
Specialty medical practices and kidney care providers signed on to participate as well, such as NY Kidney Hypertension Medicine; Devoted Medical, which is Medicare Advantage insurance startup Devoted Health's in-house medical group; CareHarmony, a chronic care management company; Mariposa Community Health Center; and Orlando Cardiac and Vascular Specialists, to name a few.
The ACCESS model targets four clinical areas that collectively represent chronic conditions impacting more than two-thirds of Medicare beneficiaries. The four categories are early cardio-kidney-metabolic (eCKM) conditions, including hypertension, dyslipidemia, obesity, overweight with markers of central obesity and prediabetes; CKM conditions, including diabetes, chronic kidney disease and atherosclerotic cardiovascular disease; musculoskeletal (MSK) conditions; and behavioral health conditions such as depression and anxiety.
But the payment rates (PDF) for the ACCESS model, unveiled in February, were lower than the industry expected and fell below current billing models.
Annual allowed amounts for the initial period, or the first year, are $360 for eCKM, $420 for CKM, $180 for MSK and $180 for behavioral health. Follow-on period rates, applicable when a beneficiary is continuing established care, are exactly half: $180 for eCKM, $210 for CKM and $90 for behavioral health. MSK does not have a follow-on period.
Many digital health experts have crunched the numbers and noted that it might not be worth the effort for high-touch, clinician-driven chronic care.
The lower-than-expected reimbursement rates introduce the risk of negative profit margins for model participants, according to a research note from strategy firm Capstone.
Capstone said the model could represent a tailwind for scaled digital health companies like Omada Health and Hinge Health. Provider referral incentives and outcome-based bonuses could drive beneficiary volume to offset margin pressure.
Omada Health did not apply for the ACCESS Model, a company spokesperson said.
In December, the Food and Drug Administration also announced plans to select about 40 devices not yet cleared by the agency to receive special agency discretion to participate in the ACCESS Model.