Technology Infrastructure for CMS ACCESS Model Participants
Deploy the Infrastructure ACCESS Requires Before the July 2026 Launch
RPM, care coordination, and outcome tracking across all four clinical tracks
FHIR-based data exchange and interoperability
built in
Outcome-aligned payment (OAP) tracking and reconciliation support
Production-ready in 4-6 weeks - not 6-12 months
The Ally Advantage
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year voluntary CMS program launching July 2026. It introduces outcome-aligned payments (OAPs) for Medicare Part B providers using technology-enabled care to manage chronic conditions. ACCESS replaces activity-based billing with payments tied to measurable health outcomes. CMS pays participating organizations a fixed annual amount per beneficiary, with 50% withheld pending demonstrated clinical improvement. The model targets four clinical tracks covering conditions affecting two-thirds of Medicare fee-for-service beneficiaries: Early Cardio-Kidney-Metabolic (eCKM), Cardio-Kidney-Metabolic (CKM), Musculoskeletal (MSK), and Behavioral Health (BH). Applications opened January 2026 with a deadline of April 1, 2026 for the July 2026 first cohort.
Why We're Different
Outcome Tracking
Track patient-level clinical outcomes against ACCESS baselines. Dashboard visibility into your Outcome Attainment Rate (OAR) across all enrolled beneficiaries before reconciliation.
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Beneficiary Enrollment Manage voluntary beneficiary enrollment and consent capture. Patient-facing communication in 120+ languages. Family and caregiver engagement through plain-language updates.
Remote Patient Monitoring
Connected device data capture for blood pressure, weight, glucose, lipids, and other track-specific measures. Threshold alerts and trend detection route to care teams with clear next-best actions.
Care Coordination
Role-based AI guidance for care managers, nurses, and clinical staff managing ACCESS patients. Protocol reminders, escalation paths, and documentation checklists built into the workflow.
Substitute-Spend Monitoring
Track Medicare FFS services received by ACCESS-enrolled beneficiaries to ensure you stay below the 90% Substitute Spend Threshold before reconciliation.
FHIR Data Exchange
API-driven interoperability for eligibility, consent, clinical data sharing, and care team coordination. Aligns with CMS Health Tech Ecosystem requirements.
The Problem
ACCESS is not a traditional care management program. It requires participants to build and operate technology infrastructure that most provider organizations do not have today. CMS requires FHIR-based API data exchange for eligibility checks, consent capture, claims and clinical data integration, and bidirectional information sharing with the patient's broader care team. Participants must track condition-specific clinical outcomes against baselines, manage the substitute-spend test to avoid duplicate FFS billing, and report risk-adjusted outcomes that CMS will publish in a public directory. Organizations that apply without this infrastructure in place will struggle to meet outcome thresholds, fail the substitute-spend test, or lose the 50% withheld payment at reconciliation. The application deadline for the first cohort is April 1, 2026. The infrastructure needs to be ready before patients enroll.
The Solution
CareAlly's platform supports all four ACCESS clinical tracks with production-ready infrastructure that deploys in 4-6 weeks. Early Cardio-Kidney-Metabolic (eCKM) - $360/year per beneficiary: Blood pressure monitoring, weight/BMI tracking, lipid panel integration, lifestyle adherence monitoring. Outcome targets: BP control, lipid improvement, weight reduction, HbA1c for prediabetes. Cardio-Kidney-Metabolic (CKM) - $420/year per beneficiary: Diabetes management with HbA1c tracking (target below 7.5% or 1-point reduction), BP and lipid monitoring, medication adherence, eGFR and uACR baseline reporting for CKD patients. Musculoskeletal (MSK) - $180/year per beneficiary: Patient-reported outcome measure (PROM) collection - PROMIS Physical Function, Oswestry Disability Index, QuickDASH, or site-specific instruments. Single 12-month care period with functional restoration targets. Behavioral Health (BH) - $180/year per beneficiary: PHQ-9 and GAD-7 baseline and follow-up administration. Outcome targets: maintain scores below 10, or achieve 5-point PHQ-9 / 4-point GAD-7 reduction. The platform integrates with your EHR, care platforms, and connected devices. AI assists with documentation, outcome tracking, and care coordination while clinical decisions stay with your team. Every output is auditable and traceable to source.