The day after America blows out 250 candles, its most expensive healthcare program is celebrating in its own way. The ACCESS program launches July 5th. The name is giving 90s nightclub vibes and the guest list is sort of exclusive too. 

Who’s invited? The 34+ million Americans on Original Medicare who may be managing high blood pressure, diabetes, chronic pain, and/or depression. This week, we're lifting the velvet rope on what the program actually does and what it means for your family.

⚖️ We’re trading our keyboard for a microphone. Gray Monster is taking over The Sandwich Generation Survival Guide podcast with attorney Candace Dellacona. If your phone-a-friend were an elder law attorney, what would you want to know? Reply to this newsletter with your questions for Candace. We’ll do the asking, anonymously, of course, and she’ll do the answering.

🧓 A 101-year-old Michigan woman still drives, swims daily, takes Zumba, and walks with her daughter. She shared her longevity advice with People.

🏔️ One retiree's trip to Alaska sparked an uncomfortable realization: he spent years planning for money and almost no time planning for friendship. Research suggests the latter may matter just as much. 

🏠 Aging at home is the goal for most older adults. Paying for it and pulling it off is the challenge.

An acronym hates to see the government coming. Short for Advancing Chronic Care with Effective, Scalable Solutions, the ACCESS Model is Original Medicare's first real attempt to pay for chronic care based on whether patients actually get better. And they’re partnering with tech companies to track the progress.  

This means Medicare will now pay for results, not just activity. ACCESS organizations receive recurring payments for managing a patient's condition, but only earn the full amount if the patient actually improves. It's called Outcome-Aligned Payment (OAP).

The conditions covered are broken into tracks:

More than two-thirds of all people on Medicare have at least one of them so there’s a chance your mom’s in the medical mix.

Who's eligible and what kind of Medicare does Mom need?

ACCESS is for people on Original Medicare only, that's traditional Part A and Part B. If Mom is on Medicare Advantage, she's not automatically included. Medicare Advantage plans can choose to offer similar programs on their own, and some are, but they're not part of this model. If you're not sure which type of coverage Mom has, check her Medicare card or call 1-800-MEDICARE.

Does Mom's doctor participate, and will she lose access to her current care?

Not necessarily, and no. ACCESS organizations are separate, tech-enabled chronic care programs, not mom's existing primary care practice. Participation is voluntary and not every provider joins. Mom's own doctor can refer her and stays informed through regular electronic updates. Her existing care doesn't go away. ACCESS works alongside it.

Enrolling doesn't change mom's Medicare coverage, rights, or provider relationships. She can keep seeing whoever she sees now, no referral from ACCESS required. One billing note: the ACCESS organization can't bill traditional Medicare fee-for-service for the same patient they're managing under ACCESS. That rule prevents duplicate payments on the government's end. It has no effect on mom's ability to see whoever she wants. Her other providers bill normally.

Will Mom have to wear a device?

While the government may not be on a first name basis with your mom, they probably know someone like her. Armed with that knowledge, they understand no one can require Mom to buy or wear anything. 

ACCESS organizations are explicitly prohibited from making device ownership a condition of participation. That said, devices are a big part of how this model works. Blood pressure cuffs, continuous glucose monitors, wearables, apps, and participating organizations are expected to provide them at no cost if they're part of the care plan. Mom can also choose to use devices she already owns if she prefers. The only things organizations can require are basic: a phone or computer, internet access, and an email address.

What does it cost?

Some ACCESS organizations may waive standard Medicare cost-sharing entirely. Others may charge it. Either way, they're required to tell Mom upfront, before she enrolls. There's no cost-sharing for the co-management visits her own doctor bills when reviewing ACCESS updates.

How does Mom sign up?

Mom can enroll directly with a participating organization or get a referral from her doctor. Once enrolled, there is a 90-day minimum period before she can switch to a different organization or voluntarily disenroll, so it's worth doing a little homework before signing up. CMS will maintain a searchable directory to help with that. One heads up: because this is a formal research model, a small number of people who try to enroll may be randomly assigned to a control group for evaluation purposes, making them ineligible for that specific track for a 12-month period. Mom keeps all her regular Medicare coverage either way.

How to find a participating organization

CMS is building a public, searchable directory of all ACCESS participants that will include the name and location of the organization, which chronic conditions they treat, and their risk-adjusted health outcomes so you can compare performance and participation.

Until that directory is fully live, here's what you can do right now:

More FAQ’s

Q: Can Mom be enrolled in more than one track at a time? A: Yes, and she can enroll with different organizations for different tracks if she chooses. Someone managing both diabetes and depression could have one ACCESS organization handling metabolic care and another focused on behavioral health. One exception: the eCKM and CKM tracks overlap clinically, so a patient cannot be in both simultaneously. If mom moves from eCKM to CKM, she can switch immediately without the standard 90-day wait.

Q: What happens to the ACCESS organization if Mom doesn't improve? A: The organization's payment gets reduced. Mom's care and Medicare coverage are unaffected. She can stay in the program or leave any time after the 90-day minimum period, and the organization is still required to meet clinical and safety standards regardless of payment.

Q: Mom's condition isn't on the list. Could ACCESS expand to cover it? A: CMS has stated it may consider additional tracks and conditions in the future. The program runs through 2036, so there is room for expansion.

Q: If ACCESS works, does it become permanent? A: It could. If the program is found to improve quality without increasing costs, or reduce costs without reducing quality, and the CMS Office of the Actuary certifies those findings, the Secretary of Health and Human Services could move to expand or make it permanent through rulemaking.

Q: What if the ACCESS organization Mom is using gets disenrolled by CMS for not meeting standards? A: CMS monitors clinical performance and can terminate organizations that fail to meet quality, safety, or outcome standards. If that happens, Mom's Original Medicare coverage remains fully intact and she can transition to another ACCESS organization or continue care with her existing providers.

Q: Does ACCESS affect how ACOs or other care arrangements work for Mom? A: If Mom's primary care doctor participates in an Accountable Care Organization, her PCP can still refer her to an ACCESS organization and bill the co-management payment for coordinating care. The two programs are designed to work together, not against each other.

Here’s last week’s results. Another quiz drops next week.

You said it. This week’s submissions.

"Mom got in a fight with a Lyft driver and flipped him the bird outside of her senior day center."

"Took kids on vacation and did not worry about my mom while away. I usually worry a lot."

"My mom said thank you to me for taking the time to come and see her and take her places."

"Helping Mom find words to express why she's frustrated can be exhausting."

"Dad remembered I got a ticket for texting while driving."

"Mom is finally trying activities in assisted living after four months."