Is the ACCESS Model the Secret to Tech-Driven Care Management Maintenance?
The initial industry reaction to the Center for Medicare and Medicaid Services (CMS)’ ACCESS Model reimbursement rates was understandably lukewarm. When comparing the ACCESS Model rates (~$15/per patient per month for Year 1) to the high-touch, labor-intensive Fee-For-Service (FFS) Virtual Care Management (VCM) rates (~$100/per patient per month), many stakeholders saw a step backward in support for chronic care.
However, viewing ACCESS merely as a lower-cost replacement for FFS VCM misses a strategic opportunity. Instead, the ACCESS Model should be viewed as the missing link for tech-driven maintenance for management of a patient’s chronic condition.
Solving the Chronic Care "Success Gap"
Historically, VCM has suffered from a clinical paradox inherent in the FFS construct: the more successful a clinical intervention is, the harder it is to sustain.
The Intensive Phase: A patient with uncontrolled chronic conditions receives high-touch care management services (like chronic care management or remote physiologic monitoring) led by clinicians. The medical practice invests significant human capital to stabilize the patient’s health.
The Stability Plateau: Once the patient is healthy and stable, the clinical necessity for intensive, monthly monitoring often diminishes.
The Continuity Gap: At this point, patients often disenroll from their care management program. This creates a care gap where the patient is no longer being monitored or managed at all, increasing the risk of a future acute episode or readmission.
Building a Permanent, Tech-Driven Care Maintenance Solution
The ACCESS Model addresses this gap by incentivizing long-term, technology driven health maintenance rather than just episodic stabilization.
By transitioning stabilized patients from FFS VCM into the ACCESS Model for "care maintenance," the referring practice (the team that did the heavy lifting to get the patient healthy) remains the clinical anchor. This allows the patient to continue receiving medically necessary oversight without the human labor burden of a clinician-led program. This transition ensures that the patient doesn't simply "exit the system" once they get healthy, but rather moves into a more efficient tier of oversight.
Why the ACCESS Model Favors AI and "Light-Touch" Scalability
The shift in reimbursement structure signals a necessary evolution: moving from expensive clinical labor to AI-driven scalability.
Automated Oversight: Stable patients don’t always require recurring clinical engagement on a monthly basis; they benefit more from continuous, "light-touch" digital monitoring that fits into their daily lives.
AI-Enhanced Triage: Leveraging AI to monitor vitals and engagement allows a single care coordinator to oversee a significantly larger patient population than a traditional FFS model allows. This expands a practice’s "reach" without exhausting its clinical staff.
Seamless Escalation: The referring practice remains the "anchor." If a patient’s data trends downward, the system triggers a proactive alert, allowing the patient to be moved back into high touch FFS care before an emergency occurs.
The Bottom Line: Moving Beyond the "Minute-Counting" Mindset
The future of Value-Based Care (VBC) isn't about how many minutes a clinician spends on remote patient monitoring; it’s about the integrity and continuity of the care management safety net. The CMS ACCESS Model allows the healthcare industry to stop penalizing providers for patient success. It transforms "stabilization" from a point of exit into a sustainable, tech-enabled standard of care. By leveraging technology to maintain health at scale, we may be able to provide the right level of care to the right patient at the right time.
Nixon Law Group Can Help Build Your ACCESS Model for Success
As Medicare moves toward longitudinal, technology-enabled oversight, the ACCESS Model offers a strategic path for digital health innovators to move beyond episodic billing. Whether you are evaluating a spot in the ACCESS Tools Directory or looking to architect a full-scale ACCESS Management Organization (AMO), Nixon Law Group provides the specialized regulatory and strategic counsel needed to thrive in this new maintenance-focused ecosystem.
Contact us to ensure your ACCESS strategy is compliant, competitive, and built for the future of Medicare.