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What’s new: Major health payers representing 165 million Americans with Medicare Advantage, Medicaid and private health insurance plans pledged to adopt an outcomes-based payment structure aligned to the Medicare-focused ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model.
Why it matters: The pledge is an important step to alignment across Medicare, Medicaid, and commercial payers around payments for technology-supported care that incentivize flexibility in care delivery, coordination with primary care and clinicians and — most importantly — measurable improvements in patient health outcomes rather than volume of services.
What to expect: The ACCESS Model begins its 10-year performance period in July 2026; under the ACCESS Payer Pledge, payers commit to offering payment arrangements that align with core principles of the model by January 1, 2028.
The big picture: Payers’ voluntary alignment to ACCESS builds on earlier support from clinician and patient societies acknowledging the necessity of making technology-supported more accessible to all Americans, empowering them to meet their health goals and prevent or manage their chronic conditions; this is just the latest example of CMS using convening power to align stakeholders towards a common goal.
Additional details: Payers that have signed the pledge include Arkansas Blue Cross and Blue Shield, Blue Shield of California, Blue Cross and Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Centene, Cigna, CVS Health, Devoted Health, Guidewell, Horizon Blue Cross Blue Shield of NJ, Humana, UnitedHealthcare.
CMS is developing a set of optional alignment resources for health plans, expected to be available later this year including:
- Reference documents, such as a sample provider agreement structure and payment adjustment code
- Standardized billing codes, including track-specific G-codes that may be used by any payer to support consistent administrative workflows
- FHIR-based reporting infrastructure, enabling payers to align on CMS’ outcome measures and direct applicable providers to submit performance data through a CMS-hosted API, with CMS returning results to payers on a recurring basis for their own payment determinations
Payer organizations that are interested in joining the pledge and learning about available CMS resources may visit the model webpage and complete the interest form.
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