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Act on ACCESS Now Before the Transition Reshapes Your Medicare Relationships

Earn referral revenue, protect FFS billing, and strengthen Medicare care relationships with Innovaccer's Population Health Operating System, built for continuous care, ready for ACCESS, and delivering outcome-focused care while absorbing outcome risk.

~$100

PMPY incremental
revenue with zero outcome risk

50%

OAP withhold captured
with AI-driven care delivery

Day 1

Fully operational,
no internal build required

What is CMS ACCESS?

A program designed for chronic care outcomes, not just visits

CMS ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year CMMI model launching July 5, 2026. It introduces recurring revenue for organizations that use technology to measurably improve chronic disease outcomes. This is not an incremental billing code. It is a fundamentally new payment pathway that rewards results, not visits.

Chronic Conditions Covered

• Hypertension
• Diabetes
• CKD
• ASCVD
• Chronic MSK Pain
• Depression & Anxiety

Recurring, outcome-aligned payments

Payment tied to measurable clinical improvement - blood pressure reduction, HbA1c control, pain improvement, symptom reduction etc. Not volume, not number of visits, just results.

Technology-supported, continuous care

CMS explicitly mandates tech-enabled care - RPM, digital therapeutics, AI-driven coaching. Manual programs cannot break even under the ACCESS economics model.

Permanent voluntary patient alignment

Patients voluntarily align to one ACCESS Participant per track. Once aligned, they cannot re-align elsewhere. First-movers lock in their Medicare population.

Medicare is redirecting revenue. Be on the right side of it.

New Revenue, Zero New Infrastructure

ACCESS unlocks a recurring payment stream from Medicare patients already under active care. Innovaccer acts as the ACCESS Participant, while referring practices earn co-management revenue. No new contracts. No new overhead.

Protect Your Medicare Patient Base

Digital health companies are actively enrolling Medicare patients now. Care coordination authority, referral influence, and revenue are permanently lost once patients enroll with someone else. Secure the population before the window closes.

Ready from Day 1

ACCESS demands AI-enabled enrollment, longitudinal outcome tracking, and FHIR-integrated CMS reporting. Innovaccer delivers all of it, fully deployed and operational before the program launches. Practices show up ready.

End-to-End CMS ACCESS Infrastructure

From patient identification to CMS reconciliation

Turn medicare chronic care population into enrolled, managed, and measurably improved patients, with Innovaccer's outcome-focused managed program.

• Identify & Stratify: Surface risk early and activate the right patients, faster. Unify clinical, claims, RPM, and PRO data into one longitudinal record, continuously scoring and assigning patients to the right ACCESS tracks, without operational overhead.
• Enroll at Scale: Turn eligibility into enrolled medicare population. Activate automated multi-channel outreach across SMS, IVR, and email alongside EHR-embedded point-of-care referrals to enroll patients at scale.
• Monitor & Intervene: Deliver smarter care during and between every visit. Monitor patients continuously, surface AI-driven risk alerts and clinical decisioning within EHR-native workflows, and extend care capacity with dedicated coach-led intervention for optimal outcomes.
• Track and Report Outcomes: Hit performance targets and simplify CMS reporting. Track cohort performance through live dashboards, automate patient-reported outcome collection, and streamline payment reconciliation with FHIR-integrated CMS API submissions.

Two ways to participate

Recommended: End-to-End Managed Program

Innovaccer manages the full ACCESS program - clinical delivery, patient enrollment, technology deployment, quality reporting, and outcome accountability. The organization earns co-management revenue with zero operational burden and zero downside risk.

• Investment: Zero upfront capital
• Risk: Zero downside exposure
• Time to Value: Weeks, not months
• Revenue: Referral while retaining existing FFS billing

Platform License

The organization owns the ACCESS participation directly. Innovaccer provides the technology platform, implementation support, and analytics infrastructure. Clinical workflows, staff hiring, and outcome risk stay with the organization.

• Investment: Platform licensing fees
• Risk: Complete risk ownership
• Time to Value: Months, build required
• Revenue: Full retention, full risk

Why Health Systems Choose Innovaccer

Built for scale. Proven in practice.

• 0M+ Patient lives connected through Innovaccer’s unified healthcare data platform, enabling providers, ACOs, and payers to activate data for better decisions and outcomes.
• 0+ Provider organizations operating on the Innovaccer platform today, including large health systems, ACOs, independent and specialty practices, managing millions of value-based lives.
• 0% Reduction in heart failure hospitalizations delivered through StoryHealth, Innovaccer's AI-powered specialty care platform, proven at scale across Medicare populations.
• #80 Population Health Platform top-ranked by Black Book. 90%+ across every KLAS category. Clinical performance, data integrity, and enterprise security - all independently verified.

Your Medicare patients will receive technology-enabled chronic care. The only question is who delivers it.

FAQ

What is CMS ACCESS?
CMS ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year CMMI model launching July 5, 2026 through June 30, 2036. It pays healthcare organizations monthly Outcome Achievement Payments (OAPs) tied to clinical targets for delivering longitudinal chronic care management to Medicare Fee-for-Service beneficiaries. Unlike traditional fee-for-service, ACCESS rewards measurable results — blood pressure reduction, HbA1c control, functional improvement — not visits or volume.

What chronic conditions does ACCESS cover?
ACCESS covers four clinical tracks. beneficiaries can be enrolled in multiple tracks simultaneously:

Who is eligible to participate in ACCESS?
Eligible participants include health systems, physician groups, Accountable Care Organizations (ACOs), Federally Qualified Health Centers (FQHCs), and other Part B billing entities with Medicare Fee-for-Service beneficiary panels. Organizations can participate as a full ACCESS Participant or through a referral relationship with an established Participant.

What is the deadline to apply for CMS ACCESS?
Applications are accepted on a rolling basis. The first cohort deadline was April 1, 2026 for a July 2026 start. Subsequent cohorts can apply throughout the model duration, with new cohorts launching annually. Organizations targeting Q1 2027 participation should begin application preparation now.

Can my organization participate in ACCESS if we are already in MSSP?
Yes. MSSP ACOs can participate in ACCESS. For 2026-2027, ACCESS Outcome Achievement Payments are excluded from your ACO's benchmark calculation, providing an 18-month financial shield. Starting in 2028, ACCESS expenditures will be included in ACO benchmark calculations.

How does ACCESS payment work?
CMS pays monthly Outcome Achievement Payments (OAPs) — 50% upfront, 50% withheld pending outcome achievement. The Outcome Attainment Threshold (OAT) is the minimum percentage of enrolled beneficiaries who must achieve clinical targets to retain the full withheld amount. In Year 1, the OAT is 50%. If fewer beneficiaries hit targets, the withheld amount is reduced proportionally, up to a maximum 50% reduction.

What are co-management payments in ACCESS?
Co-management payments compensate referring providers for reviewing and acting on clinical updates from the ACCESS Participant. ACCESS Model reimbursements are approximately $30 per service, with a $10 modifier for the initial onboarding visit. CMS compensates referring providers up to ~$100 per beneficiary per year through co-management billing, once every four months per track — while retaining their existing fee-for-service billing without new infrastructure or compliance obligations.

Why does ACCESS require technology-enabled care?
CMS explicitly mandates tech-enabled care delivery, including remote patient monitoring, digital therapeutics, and AI-driven coaching. Manual programs cannot break even under the ACCESS economics model — the payment structure is designed for scalable, technology-driven chronic care delivery.

Why does beneficiary alignment matter for first-movers?
Beneficiaries voluntarily align to one ACCESS Participant per track and cannot re-align elsewhere.

How does Story Health Partners support Referring Organizations in ACCESS?
Story Health Partners offers an end-to-end program where Story Health Partners manages clinical delivery, continuous monitoring, and outcome tracking that will be shared with the aligned beneficiary’s primary care provider.

How long does it take to launch an ACCESS program with Story Health Partners?
Organizations that refer to Story Health Partners can launch ACCESS programs in 60-90 days through the managed program model, compared to 12-18 months for organizations building infrastructure to participate directly.

How is Story Health Partners different from competitors?

• Proven outcomes with Story Health
• EHR-native workflows
• Data + Intelligence + Delivery in one
• Data Stewardship

Does Story Health Partners integrate with Epic, Cerner, and other EHRs?
Yes. Story Health’s platform integrates with all major EHR systems — Epic, Oracle Cerner, MEDITECH, Athenahealth, and others — through HL7, FHIR, and direct API connections. Clinical data flows bidirectionally, ensuring providers maintain full visibility into beneficiary care within their existing workflows.

How do I learn more about ACCESS participation with Story Health Partners?
Visit innovaccer.com/cms-access or contact your Innovaccer representative. Organizations targeting Q1 2027 participation should begin application preparation now.