CMS Expands ACCESS Model: A New Frontier for Digital Health in Chronic Disease Management

By Elise Reuter | Sept. 16, 2026

In a significant pivot toward technology-integrated care, the Centers for Medicare & Medicaid Services (CMS) has announced a major expansion of its "Advancing Chronic Care with Effective, Scalable Solutions" (ACCESS) model. Launched just two months ago, the initiative is designed to fundamentally alter how Medicare pays for digital health interventions. By broadening the scope of covered conditions to include heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and tobacco cessation, the federal government is signaling that digital health is no longer a peripheral experiment but a core component of the future Medicare infrastructure.

The Scope of the Expansion: Targeting Chronic Complexity

The ACCESS model was conceived as a 10-year, ambitious experiment to address the escalating costs and complexities of chronic disease. Under the new expansion, scheduled to take effect in the spring of 2027, the program will encompass a wider array of health tracks, effectively touching the lives of approximately three in four Medicare beneficiaries.

Jacob Shiff, the CMS Chief AI and Technology Officer, highlighted the strategic importance of this rollout during a Tuesday presentation. “By integrating heart failure, COPD, and substance use support into the ACCESS framework, we are meeting patients where they are—using the tools they already engage with to manage conditions that have historically driven the highest costs in the Medicare program,” Shiff stated.

Beyond the new clinical categories, the expansion includes a critical policy shift regarding musculoskeletal care. Previously, the program supported these conditions for a 12-month period. Under the new guidance, CMS will provide ongoing support beyond that initial window, acknowledging that for many seniors, musculoskeletal health requires sustained, long-term digital oversight to prevent mobility loss and chronic pain.

Chronology of the ACCESS Model: A Rapid Evolution

The journey of the ACCESS model from concept to massive expansion has been marked by a breakneck pace of implementation:

• Mid-2026: The ACCESS model officially launches, targeting cardio-metabolic, musculoskeletal, and behavioral health conditions.
• Late 2026: CMS reviews initial engagement data, noting significant interest from non-traditional healthcare companies.
• September 2026: CMS announces the expansion of the program, adding heart failure, COPD, substance use, and tobacco cessation to the covered tracks.
• Spring 2027 (Anticipated): The expanded conditions become eligible for reimbursement under the model.
• 2026–2036: The 10-year life cycle of the model begins in earnest, with iterative updates expected as digital health data matures.

Data-Driven Care: How the Model Functions

The core mechanism of the ACCESS model is a shift toward outcomes-based reimbursement. Participating health organizations do not simply bill for a service; they earn monthly payments based on the efficacy of the digital technologies they deploy to manage chronic conditions.

According to CMS, more than 160 companies have already been approved for participation. A notable feature of this cohort is that the majority of these entities have never worked within the Medicare ecosystem before. This represents a deliberate attempt by CMS to attract "digital-native" companies that bring agility, machine learning capabilities, and user-centric design to the traditional, often stagnant, world of chronic disease management.

The participants include a diverse array of innovators:

• Telehealth Providers: Small, specialized outfits focusing on remote monitoring.
• Digital Wellness Platforms: Companies like Headspace, which are integrating meditation and mindfulness into clinical care plans.
• AI-Enabled Tools: Companies like Welldoc, which utilize AI-driven chatbots to provide real-time patient support.
• Wearable-Integrated Services: Physician groups specifically founded to leverage data from hardware like Whoop, allowing for a "closed-loop" approach to patient health.

The FDA-CMS Synergy: The TEMPO Pilot

One of the most innovative aspects of the current strategy is the parallel program between the FDA and CMS, known as the Technology-Enabled Meaningful Patient Outcomes (TEMPO) pilot. Recognizing that the regulatory timeline for new devices often clashes with the urgent need for clinical innovation, the FDA has created a pathway for digital health devices that have not yet received full traditional authorization to collect real-world evidence within the ACCESS program.

Four initial participants have been selected for this "regulatory sandbox," including:

1. SonderMind: Applying AI to behavioral health, helping providers track patient progress more objectively.
2. Limbic: A pioneer in AI voice agents for therapy, providing patients with immediate mental health support.
3. Cadence Solutions: Focused on hypertension management through data-supported remote care.
4. Dexcom: A leader in continuous glucose monitoring (CGM), now testing how real-time data integration can lower A1C levels more effectively in a Medicare-reimbursed environment.

CMS Administrator Dr. Mehmet Oz has been a vocal proponent of this "frictionless" approach. During his recent remarks, he framed the collaboration as a necessity. "We are effectively dismantling the silos between the FDA and CMS," Oz said. "We want technologies to move through the government apparatus efficiently so that innovators don’t have to fight multiple gauntlets to get the support they need to help patients."

Implications for the Broader Healthcare Ecosystem

While the ACCESS model is currently limited to traditional Medicare, its influence is rippling outward. Private and commercial payers have recognized the writing on the wall: the "digital-first" model for chronic care is the new benchmark for efficiency and patient outcomes.

Major players—including Blue Shield of California, Cigna, CVS Health, and UnitedHealthcare—have signaled their intent to adopt payment structures that align with the ACCESS model. This voluntary alignment is critical; it creates a unified market for digital health companies. If a developer builds a tool for COPD management, they can theoretically deploy it across Medicare, Medicaid, and private insurance plans without redesigning their billing infrastructure for every payer.

Challenges and Considerations

Despite the optimism, the model faces significant hurdles:

• Data Privacy: As more companies—particularly those without prior healthcare experience—gain access to sensitive Medicare beneficiary data, the burden of cybersecurity will intensify.
• The Digital Divide: There is a lingering concern that relying on digital health tools could inadvertently exclude elderly or lower-income populations who lack reliable internet access or technological literacy.
• Outcome Verification: The shift to "outcomes-based" payment sounds ideal in theory, but defining and measuring those outcomes in a way that is both fair to companies and protective of taxpayer dollars remains a complex statistical challenge.

Looking Ahead: A New Standard of Care

The expansion of the ACCESS model signals a maturation of the digital health sector. By moving beyond simple "wellness" apps and into the clinical management of complex conditions like heart failure and COPD, CMS is testing the hypothesis that technology, when integrated into the payment structure, can bend the cost curve while improving patient health.

For the 160-plus companies involved, the next few years will be a crucible. Those that can prove their tools genuinely improve outcomes—not just engagement metrics—will likely define the next decade of healthcare delivery. As the program enters its second phase, the focus will shift from initial enrollment to long-term impact analysis. If the ACCESS model succeeds, it will likely serve as the blueprint for the entire U.S. healthcare system, moving us closer to a future where high-quality, continuous care is delivered through a smartphone, a wearable, or an AI-driven platform, regardless of the patient’s physical location.

The government has placed a massive bet on the ability of private innovation to solve the chronic disease crisis. As we look toward the spring 2027 rollout, the eyes of the healthcare world will be fixed on whether these digital solutions can deliver on their promise of a healthier, more connected, and more sustainable Medicare system.