The CMS Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model went into effect on July 5. The 10-year, voluntary model aims to bring “technology-supported care” options to chronic condition management for Medicare beneficiaries. Per CMS, tech-supported care may include patient education, virtual consultations, medication management, counseling, lifestyle and behavioral support, and remote monitoring using FDA-authorized devices.
At its launch, ACCESS includes four clinical tracks: Behavioral health (depression and anxiety), chronic musculoskeletal pain, early cardio-kidney-metabolic conditions (eCKMs) such as high blood pressure and prediabetes, and later-stage cardio-kidney-metabolic conditions (CKMs) such as diabetes, chronic kidney disease, and heart disease. CMS may consider additional clinical tracks over time.
There are more than 150 ACCESS Model accepted applicants. Many recognizable names are in specific clinical tracks, such as Headspace for behavioral health and Weight Watchers for eCKM. All told, 50 organizations are participating in all four clinical tracks; they range from provider groups to community health centers to technology vendors.
Here’s a look at some of the leading ACCESS participants that are operating nationally and participating in all four clinical tracks. There’s a clear theme of virtual care and remote monitoring augmented by AI, though each approach has nuanced differences.
Attune AI makes Agentic Voice, which provides automated outreach for care coordination (including post-discharge instructions) and preventive care (such as wellness education and screening reminders). Health systems can build custom flow logic for voice interactions, including handoff and escalation logic; this can help provide predictable behavior patterns, which is helpful for scalability as well as auditability.
CareHarmony looks at chronic care management and remote patient monitoring (RPM) from the broader lens of preventive care. The company recently introduced CareBlocks, which are interventions that its software recommends for patients based on the details of their medical records – which can include biometric data thanks to the integration of RPM devices with EHR and other clinical applications.
Castlight Health serves employers and health plans, emphasizing care navigation and member engagement. Members are connected with care guides who have access to AI tools providing next-best action recommendations for in-network interventions and services. The company has nearly 40 digital health partners to help support condition management and general wellness.
GamePlan Medical emphasizes senior care anchored by a “GamePlan Score” that measures physical, mental, and functional and paired with community-based touchpoints such as pharmacies, mobile health vans, and food/nutrition support. The company’s care navigators have AI-enabled tools to support patients and their families manage care and connect to their care team.
GenieMD provides an all-in-one virtual care platform that offers access to prescriptions, labs, chronic care management, and longevity care guided by board-certified physicians as well as medical-grade AI. The product is free for single practitioners, with scripts and labs available as add-ons billed monthly, which offers a low barrier of entry for physicians hoping to leverage ACCESS to support patients.
IntelaCare describes itself as a “care companion” that includes virtual care, remote monitoring, and patient-facing applications for chronic care and behavioral health management – all supplemented with conversational AI and voice assistants. The company has experience working at scale through customers such as Army Medical Command and the Department of Veterans Affairs
MDchronic is another virtual care platform, but the company differentiates itself by providing patients with a set of smart devices at no charge and using the data collected to create tailored care plans for numerous chronic conditions. MDchronic works directly with qualified Medicare beneficiaries and customers in the small business, health plan, and benefits advisor markets.
Nationwide Vitals focuses primarily on home-based blood pressure monitoring, with daily readings supported by monthly check-ins from the company’s care team (and interventions form the care team and a patient’s PCP if necessary). The company supplies the blood pressure cuff, and it doesn’t require Wi-Fi, Bluetooth, or a smartphone sync – valuable features to support patients aging in place.
Nudj supports cardiometabolic health with a combination of clinical care, connected devices, and analytics to power personalized recommendations. Two aspects of the company’s offering stand out: An in-house content team that creates custom messaging and RCM services to help physician practices properly bill and collect for lifestyle medicine services.
SynsorMed calls its offering “remote care as a service” that enables payers and providers to support remote monitoring and chronic care without standing up their own programs. The company will assess patient/member data to identify eligible individuals, and its platform couples clinical care with AI-driven sentiment analysis that adapts outreach based on how interactions are going.
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