Seth Crossley

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is CMS’ attempt to finally bridge the gap between how chronic care actually happens and how Medicare pays for it. The model introduces Outcome‑Aligned Payments tied to measurable clinical improvement which is a major departure from traditional fee‑for‑service. It also explicitly encourages technology‑supported care: remote monitoring, digital tools, AI‑enabled workflows, and continuous engagement outside the four walls of the clinic. A few things stand out to me as I think about the implications: 1.) This is a 10‑year model. -CMS is signaling long‑term commitment. -ACCESS runs for a full decade. This gives organizations time to build, iterate, and scale technology‑enabled chronic care models. 2.) It targets high‑impact clinical areas. -Two-thirds of Medicare beneficiaries are affected by the target conditions: hypertension, obesity, diabetes, CKD, CVD, MSK and MSK pain, behavioral health -Vendors that target these conditions should pay extra close attention to this model 3.) Vendors have a real role here. -More than 500 technology‑enabled care organizations have already expressed interest in ACCESS. -Providers will need partners who can support monitoring, engagement, analytics, and outcome measurement at scale. 4.) The initial application window is around the corner. -For those aiming for the first performance period beginning July 2026, applications are due April 1, 2026.

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Medicare Advantage revenue is expected to increase 0.09% in 2027. Based on history, the final amount will likely be higher... Yesterday CMS released their Advance Notice on MA Capitation Rates for 2027. The overall expected Revenue change is 0.9% (2.54% including the "MA Risk score trend" component). This is down from the Final 2026 amount of 5.06% (7.16% including the "MA Risk score trend" component). Historically, the final amount ends up being higher than the Advance Notice amount. Over the last 5 years, the average lift between Advance Notice and Final is 1.15%. If this holds true for this year, the Final expected Revenue increase will be ~1.24% (~3.7% including the "MA Risk Score Trend" component). It’s worth noting that the industry expected these numbers to be higher. Mostly due to the higher trends seen in Medicare claims over the last few years. The final rule (which will be released in April) may include more of this higher trend in the calculation. It’s also worth mentioning that the overall expected rate change is negatively impacted (-1.53%) by a change to “exclude diagnoses from unlinked chart review records on risk scores”. __ If you are a leader in the Medicare industry give me a follow. I post insights daily! P.S. - sign up for my weekly newsletter "Medicare Market Insights" https://lnkd.in/gmv65ipM

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