Is this the turning point for Value-Based Care? CMS launches the ACCESS Model

CMS is launching the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) on July 5, 2026. It is a 10-year pilot that reimburses providers based on patient health outcomes rather than services delivered. The program covers Medicare, which accounts for over 20% of US healthcare spending.

The conditions targeted are chronic and high-cost: diabetes, hypertension, chronic kidney disease, obesity, depression, anxiety, musculoskeletal conditions, and cardio-kidney-metabolic care. These represent the bulk of Medicare spending and the areas where outcome-based models have the most room to improve both quality and cost.

CMS selected over 150 organizations, split roughly into thirds. The first third are digital health platforms, the primary target audience for this model. The second third are traditional providers: physician groups, health systems, FQHCs, and home care organizations. The final third are specialists and enablers: kidney care, cardiology, behavioral health specialists, device makers, and infrastructure providers.

This mix is deliberate. By bringing digital-first platforms into the same program as traditional providers, CMS is creating a competitive environment where outcomes, not incumbency, determine reimbursement. It democratizes participation and forces innovation across delivery models.

The US healthcare system presents a striking paradox. Per capita spending exceeds $12,000 annually, nearly double the average of peer nations. Yet life expectancy sits at just 79 years, among the lowest of comparable economies. At the same time, the US captures over 60% of global HealthTech and AI investments.

The broken system combined with an abundance of innovation creates the conditions for structural reform. The ACCESS Model is an attempt to channel that innovation toward outcomes rather than volume. If it works at scale over 10 years, it could become the most significant shift in US healthcare payment since the introduction of DRGs.

Providers are already spending 20x more on AI than payers. AI is reshaping the healthcare value chain unevenly: coding intensity is increasing costs for payers, care navigation platforms like Transcarent are letting self-insured employers bypass insurers entirely, and AI platforms are offering payers efficiency tools at the cost of dependency.

Health plans face four key pressures: the +20% coding intensity driven by AI-assisted documentation, commoditization as payment infrastructure becomes standardized, bypass layers that cut insurers out of the middle, and growing reliance on AI vendors. Strategic responses include deploying AI-driven claims adjudication, automating administrative processes, adopting AI-enabled reimbursement codes, building payment infrastructure, advancing value-based care models, developing proprietary care navigation, and optimizing the operating model for an AI-native world.

Germany's Health Finance Commission (FKG) delivered 66 short-term cost measures for 2027, but the focus remains limited to cost containment and budget shifts rather than structural efficiency gains. A second reform report is due by end of 2026. The ACCESS Model offers a template for how Germany could move beyond incremental cost-cutting toward outcome-based payment at scale.

In France, the newly formed Cercle Asclepios (Sante pour tous), a non-partisan think tank chaired by Franck von Lennep, is bringing together healthcare leaders to develop proposals for population health and access. France's single-payer system (Securite Sociale) provides a structural advantage for implementing outcome-based models, though this advantage is paradoxically often framed as a constraint rather than an enabler.

Both countries should study how the ACCESS Model integrates digital health platforms alongside traditional providers, creating competitive pressure that rewards innovation and outcomes rather than protecting incumbents.