The Centers for Medicare and Medicaid Services has launched a new payment model focused on giving Medicare beneficiaries with chronic conditions, including behavioral health conditions, greater access to technology.
Historically, Medicare did not reimburse for many digital health and technology services.
The new ACCESS model (Advancing Chronic Care with Effective, Scalable Solutions) enables Medicare-enrolled provider organizations to opt into Outcome-Aligned Payments through the CMS Innovation Center, paying providers based on outcomes achieved.
Unlike the traditional fee-for-service model, providers will get recurring payments for managing a patient’s chronic condition, with full payment tied to outcomes.
“ACCESS will help people meet their health goals and help remove barriers for clinicians who want to integrate technology into their care,” Abe Sutton, director of CMS, said in an announcement. “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.”
The program will focus on four distinct tracks, including one for behavioral health conditions, which includes specifically anxiety and depression. Each track will then have targeted measures and outcomes that providers will be tasked with demonstrating.
“Each clinical track includes a set of guideline-informed, condition-specific measures and outcome targets,” CMS wrote on its FAQ page. “CMS determines payment based on the overall share of patients who meet their defined outcomes, compared to a minimum threshold that increases with each participation year. This balances accountability with accessibility and rewards strong overall performance.”
The new model reflects two driving forces in the Medicare sector today: a move towards value-based payment and increased technology adoption. CMMI has rolled out value-based behavioral health initiatives under previous administrations. For example, in 2024, it announced the Innovation in Behavioral Health (IBH) model, which focused on integrating physical health programs into behavioral health settings through value-based care.
