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Medicare's ACCESS Model Just Added Heart Failure, COPD, Substance Use and Tobacco Tracks: Where the Money Is for Investors and Founders in Outcome-Paid Chronic Care in Original Medicare
CMS just expanded the ACCESS Model to add heart failure, COPD, substance use disorders, and tobacco cessation starting April 2027. Here is why this matters more than the press release suggests.
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Table of Contents
What got announced and why the press release undersells it
The payment mechanics, or how a 420 dollar check becomes a 210 dollar check with homework
Heart failure and COPD: the RPM graveyard gets a second life
Substance use disorder and tobacco: the track nobody priced in
The MSK extension and what it tells you about how CMMI thinks
Referral plumbing, co-management codes and the ACO wrinkle
The payer pledge and why 165 million lives is the real headline
Where the money is for founders
Where the money is for investors
The bear case, because there is always a bear case
What to actually do this week
Table of Contents
CMS announced on Sept 15, 2026 that the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) will add heart failure, COPD, substance use disorder, tobacco cessation, and a follow-on chronic musculoskeletal pain track starting April 1, 2027
ACCESS launched July 5, 2026 with four tracks (early cardio-kidney-metabolic, cardio-kidney-metabolic, MSK, behavioral health), more than 160 participants as of September 16, 2026, a 10 year runway, and Outcome-Aligned Payments that withhold half the money until outcomes are proven
Current allowed amounts: eCKM 360 dollars initial and 180 follow-on, CKM 420 and 210, MSK 180 with no follow-on, BH 180 and 90, plus a 15 dollar rural adder on the cardiometabolic tracks; new-track rates are not yet published
The model is Original Medicare only, but payers covering roughly 165 million lives across MA, Medicaid and commercial have pledged to adopt an aligned structure by January 1, 2028, which is where scale actually lives
The opportunity is not “build another RPM company.” It is picking the right lane: full-stack ACCESS participant, infrastructure vendor to participants, referral and co-management enabler for PCPs and ACOs, or roll-up of subscale participants once public outcome data separates winners from tourists
Bear case is real: 50 percent withhold, FFS billing lockout for aligned beneficiaries, substitute spend clawbacks, and a 2028 inclusion in ACO benchmarks that changes referral incentives
What got announced and why the press release undersells it
Every CMS press release reads like it was written by a committee that lost a bet, and this one is no exception. Strip the boilerplate and the substance is this: the ACCESS Model, which went live on July 5, 2026 and is scheduled to run ten years, is adding five things effective April 1, 2027. Heart failure. COPD. Substance use disorders covering opioids, alcohol and other substances, with co-occurring depression and anxiety folded in. Tobacco cessation. And an extension of the musculoskeletal track so that certain chronic pain conditions get ongoing support past the original 12 month care period via a new follow-on chronic MSK track. Participation count is now described by CMS as “more than 160” organizations, CMS says it will keep adding through the life of the model, and a public directory at Medicare.gov/ACCESS (currently surfaced under CMS’s coordinating-care pages) is supposed to show who treats what and, eventually, how well.
That last bit matters more than the condition list. CMS is saying it will publish risk-adjusted outcomes by participant. In a category where the entire business model of the last decade was “sell a dashboard to a health system and never measure anything,” a federal scoreboard is a genuine plot twist. Three out of four people with Original Medicare already qualify for at least one track. Add heart failure and COPD, two of the highest cost and highest readmission diagnoses in the entire program, and you are talking about a payment vehicle that touches a very large share of traditional Medicare’s chronic disease spend.
The framing from the administrator was about people falling through the cracks between appointments and about AI-enabled tools, wearables and remote monitoring. Fine. The framing that matters for anyone reading this newsletter is different: Original Medicare has never had a clean way to pay a non-traditional care organization a recurring amount for managing a condition and then dock that amount if the patient did not get better. Fee for service pays for activities. Chronic care management codes pay for minutes. RPM pays for days of device transmission and blocks of clinician time. None of it pays for a systolic blood pressure that went from 160 to 140. ACCESS does, and the new tracks extend that logic into the diseases where the outcome measures are hardest and the dollars are biggest.
