Something significant is happening in Medicare right now. And most people are missing it.
The CMS ACCESS Model, a 10-year initiative to transform chronic care in Original Medicare, launched just as major insurers announced plans to drop over 1 million seniors from their Medicare Advantage plans. That timing is not a coincidence.
On one side, the nation’s largest MA insurer announced it will drop approximately 1 million seniors from its Medicare Advantage plans for 2026 [3], the biggest pullback in decades. Another top-five insurer expects to lose 550,000 members. Insurers are slashing broker commissions mid-enrollment to discourage sign-ups for plans they now consider unprofitable.
On the other side, CMS launched the ACCESS Model, a 10-year initiative that could reshape how Original Medicare delivers chronic care.
These two developments are connected. And understanding that connection matters for anyone working in value-based care.
Why the CMS ACCESS Model Is Launching Now: The Medicare Advantage Reckoning
The numbers are stark. The nation’s largest MA insurer is exiting 16 markets entirely for 2026. One executive told investors [3] that “medical trend pressure is increasing the cost of healthcare, and the funding cuts to the program are degrading choice, access, and value to the consumer.”
Meanwhile, several major MA insurers have halted or cut broker commissions on certain Medicare plans [7], some even cutting off access to online enrollment portals. The message is clear: they do not want new enrollees who might cost them money.
Washington State Insurance Commissioner Patty Kuderer called the practice “unethical” [8], writing that “manipulating the Medicare Advantage market in a manner that harms Washingtonians eligible for Medicare” undermines consumer choice.
This is the backdrop against which the CMS ACCESS Model arrives. While Medicare Advantage contracts, the CMS Innovation Center (CMMI) is testing whether fee-for-service Medicare can deliver better chronic care through outcome-based payments.
What Is the CMS ACCESS Model?
The CMS ACCESS Model [1] (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year national test of Outcome-Aligned Payments in Original Medicare. It targets conditions affecting more than two-thirds of Medicare beneficiaries: hypertension, diabetes, chronic kidney disease, obesity, chronic pain, depression, and anxiety.
The fundamental shift: the CMS ACCESS Model will pay participating organizations Outcome-Aligned Payments (OAPs) based on whether patients actually get healthier, on top of standard fee-for-service payments for visits and activities. Providers get both.
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What Experts Are Saying About the CMS ACCESS Model
Dr. Mehmet Oz, CMS Administrator, explained the model’s rationale [4]: “ACCESS introduces a way of paying for care that focuses on results. It offers clinicians a new predictable payment option, giving them the flexibility to use digital tools that help people take charge of their health.”
Abe Sutton, Director of the CMS Innovation Center, added [4]: “ACCESS will help people meet their health goals and remove barriers for clinicians who want to integrate technology into their care. It will also make it easier for primary care doctors to partner with technology-supported care providers so they can continue supporting patients with chronic conditions even when they step outside the doctor’s office.”
Access for Health, a digital health coalition, stated [5]: “Medicare beneficiaries increasingly expect the same innovation and flexibility in their care that they experience in other parts of their lives. Today, CMS is signaling that Medicare must evolve to meet those expectations.”
Legal experts at Foley Hoag observed [6] that ACCESS “provides fee-for-service with a boost that allows providers and provider-led efforts to better compete with existing Medicare Advantage flexibilities.”
And Laura Skopec, Senior Research Associate at the Urban Institute, raised concerns [7] about how MA market dynamics are already limiting consumer choice: “Some plans are not being talked about because commissions are not being paid.”
Wynda Clayton, Director of Risk Adjustment Coding & Compliance at RAAPID and former RADV auditor with over 30 years in healthcare, sees the ACCESS Model as validation of a principle she has taught throughout her career: “Whether you succeed under ACCESS or any outcomes-based model, it comes down to the same thing. If you want to get paid for improving a patient’s blood pressure, you need documentation that shows where they started, what you did, and proof of the outcome. Providers did not go to school for coding. They went to school to take care of patients. So do not talk to them about codes. Talk to them about documentation.”
Why the CMS ACCESS Model Matters Now
The MA model worked beautifully when insurers could attract healthy members, capture risk adjustment revenue, and offer flashy supplemental benefits. But the economics have shifted. Medical costs are rising. CMS is tightening payment rates.
And now insurers are pulling back, dropping members, and manipulating broker incentives to avoid enrolling people who might actually need care.
The CMS ACCESS Model offers a different path.
It does not require a massive administrative infrastructure. It does not require insurers to manage network contracts or prior authorization systems. It pays for one thing: making patients healthier.
For organizations that can demonstrate they actually improve patient health, the ACCESS Model creates a pathway that did not exist before. But the foundation remains unchanged: accurate, complete documentation that can prove outcomes.
To participate in ACCESS, organizations must meet specific technology adoption requirements. CMS expects participants to use certified health IT, integrate remote monitoring capabilities, and maintain a data infrastructure that can track patient outcomes over time. These requirements are not optional add-ons. They are core to how the model operates.
This is where AI-driven tools can help. Not just by surfacing diagnosis gaps, but by identifying where documentation fails to support the management of chronic conditions. For example, a patient with diabetes may have the diagnosis coded, but the documentation may lack evidence of ongoing monitoring, treatment adjustments, or outcome tracking. AI can flag these gaps in real time, prompting clinicians to document the full picture of care delivery.
But the technology is just a tool. The discipline has to come from leadership. From culture. From making accuracy a priority.
CMS ACCESS Model Timeline and Key Dates
The CMS ACCESS Model will run for 10 years, from July 1, 2026, through June 30, 2036 [2]:
January 12, 2026: CMS begins accepting applications.
April 1, 2026: Application deadline for first cohort.
July 1, 2026: Model launches with first cohort.
January 1, 2027: Second cohort begins.
CMS will accept applications on a rolling basis through early 2033.
The Bottom Line on the CMS ACCESS Model
Medicare is at a crossroads. The Medicare Advantage market that promised choice and innovation is now actively limiting both. Insurers are dropping members, cutting benefits, and discouraging brokers from enrolling anyone who might cost money.
Meanwhile, CMS is building something new in Original Medicare. The CMS ACCESS Model is not perfect. Payment amounts are still unclear. Operational details need to be finalized. But the direction is clear: pay for results, not activity.
For organizations that can demonstrate they actually improve patient health, the CMS ACCESS Model creates a pathway that did not exist before.
For the 1 million seniors about to lose their current MA coverage, Original Medicare with CMS ACCESS Model participation may soon offer something better than what they are losing.
The 10-year runway starts in July 2026. The shift has already begun.
Frequently Asked Questions
A 10-year CMS initiative testing outcome-aligned payments for technology-supported chronic care management in Original Medicare, launching July 2026.
Rising medical costs and tighter CMS payment rates have made certain MA plans unprofitable, leading major insurers to exit markets and reduce benefits.
Medicare Part B-enrolled providers and suppliers (excluding DME and laboratory suppliers) with a designated physician Clinical Director.
No. ACCESS is only for Original Medicare beneficiaries, though MA plans may offer similar programs independently.
Organizations receive standard fee-for-service payments for visits and activities, plus Outcome-Aligned Payments (OAPs) tied to achieving measurable health outcomes based on each patient’s baseline. Providers get both.
Four tracks: early cardiometabolic (hypertension, obesity, prediabetes), cardio-kidney-metabolic (diabetes, CKD, cardiovascular disease), musculoskeletal (chronic pain), and behavioral health (depression, anxiety).
