By David Harvey, CMS Product Manager, Cedar Gate Technologies, an IQVIA Business
LinkedIn: David Harvey
LinkedIn: Cedar Gate Technologies
Managing chronic diseases remains a significant challenge in U.S. healthcare, both in terms of the total cost of care and poor patient outcomes. The Centers for Disease Control and Prevention (CDC) estimates that 90% of the nation’s $5.3 trillion annual healthcare expenditures go toward preventing, treating, and managing chronic disease (including both physical and mental health chronic conditions).
The sheer number of Americans impacted by chronic disease is significant and growing. Six in 10 Americans have at least one chronic health condition, and four in 10 have two or more. Chronic disease is a factor in eight of the 10 leading causes of death. Further, the risk of developing a chronic condition and experiencing complications or premature death from these conditions increases with age, demographic factors, and social determinants of health—such as a person’s education level, access to care, and the neighborhood in which they live.
Decades of managing chronic disease in a fee-for-service healthcare system has yielded only limited progress. While the Centers for Medicare and Medicaid Services (CMS) has attempted to address these challenges through accountable care organizations (ACOs) and other alternative payment models (APMs), most of their efforts to date have focused on total cost of care initiatives rather than targeting prevention and intervention directly at the source.
In December 2025, CMS introduced its latest effort to tackle the burden of chronic disease in the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model. It went live in early July 2026, and while it remains voluntary for providers to participate, ACCESS signals a clear focus on finding innovative ways to improve the quality of life for Medicare patients with chronic diseases.
The model tests an outcome-based payment framework that incentivizes technology-enabled chronic condition treatment and management. Practically, it could impact more than two-thirds of Traditional Medicare beneficiaries with hypertension, diabetes, chronic musculoskeletal pain, and depression.
Shifting Accountability Changes the Economics of VBC
In most major APM initiatives, CMS evaluates performance and structures financial incentives using population-level metrics. The accountability model shifts under ACCESS, creating a clearer connection between the interventions a provider uses and the outcomes at an individual patient level. The American Medical Association and its physician members have praised ACCESS as an opportunity to integrate effective digital solutions for Medicare patients and focus on factors providers can directly influence, encouraging care teams to identify risk early and continuously engage patients in their disease management efforts.
However, this presents a challenge for many organizations, because they lack the technology and data infrastructure to identify risk and evaluate outcomes at the level ACCESS requires. Fragmented data and silos between analytics and care tools present significant challenges in coordinating care and tracking outcomes, creating barriers to successfully measuring performance and identifying opportunities for improvement in this new model.
While nearly every other CMS model focuses on total cost of care benchmarks that span entire populations, ACCESS focuses on managing a targeted condition in specific patients—tracking treatment plans, monitoring progress, and encouraging adjustments to clinical care that can change patient outcomes. The ability to influence outcomes so directly, and CMS reimbursements, by extension, can empower more providers and care teams to confidently participate in this APM.
Turning Insights into Action with Analytics and AI
Healthcare has shifted to a technology-enabled ecosystem as demand from CMS and commercial payers to reduce costs and improve outcomes continues to increase. However, many organizations still struggle with legacy systems that cannot readily support VBC at the scale necessary to achieve cost and quality targets in models like ACCESS.
ACCESS highlights the critical need for advanced analytics and a fully integrated data management system that support AI-assisted decision-making. When these tools are capable of seamlessly translating analytics insights into care workflows, physicians get a cohesive view of a patient’s health, treatment plan, progress from baseline metrics, and condition-specific outcome targets.
Care teams can also use the same tools to quickly identify high-risk patients, uncover critical care gaps, and prioritize interventions before they escalate to costly utilization events, such as a preventable ER visit or an avoidable hospital admission.
What Will Designate Leaders in CMS’ Access Model
As models like ACCESS put the focus on patient-level measurement and accountability, software that enables complete, cohesive, collaborative care becomes a strategic necessity. Data interoperability within an organization’s healthcare IT ecosystem is no longer nice to have, it is essential to give physicians and care teams a comprehensive view of patients’ current health and treatment plan—as well as the ability to drill down deeper to see exactly what is happening with each patient’s healthcare journey. AI-assisted decision-making software also becomes vital as a tool to predict patient needs and highlight intervention opportunities that will lead to better outcomes.
The organizations that will thrive in ACCESS today, and be ready to participate in new models from CMS in the future, are building integrated data ecosystems and embedding analytics insights and decision support tools into clinical workflows. They are learning how to optimize technology to support continuous patient engagement rather than episodic intervention when a patient’s needs become acute.
ACCESS reflects the next phase of value-based care: precise accountability tied to measurable outcomes. As CMS evolves its approach to value-based care, strategic investments in the technology infrastructure to support this level of accountability and measurement are essential for success.