CMS’s New ACCESS Model: A Transformative Moment for Chronic Care—and a Major Step Forward for Virtual MSK
The Centers for Medicare & Medicaid Services (CMS) recently announced the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions)—a groundbreaking 10-year initiative that redefines how chronic conditions will be managed and reimbursed across the United States. Among the model’s four core clinical tracks is chronic musculoskeletal (MSK) pain, one of the nation’s most prevalent and costly conditions.
While CMS has yet to release the specific payment rates, the intent is clear:
outcome-driven, technology-enabled MSK care is now a federal priority.
This promising shift validates the vision shared just weeks ago by LainaHealth founder and CEO Ryan Eder. In his November 17th Healthcare IT Today Op-Ed, “Virtual MSK Went Mainstream, But Real Access Is Still Missing,” Eder championed the path forward, emphasizing that unlocking the full potential of virtual MSK requires integration into medical benefits, deep provider alignment, and a steadfast commitment to outcomes.
ACCESS is, in many ways, the model he called for.
And critically, it is the model LainaHealth has already been delivering for the past two years.
What the ACCESS Model Entails
ACCESS is CMS’s 10-year national test of a new chronic care payment framework. It enables organizations to receive recurring Outcome-Aligned Payments (OAPs) for helping Medicare beneficiaries manage chronic conditions through:
- Telehealth-based evaluations
- Technology-enabled care plans
- Remote monitoring
- AI-powered support and engagement
- Continuous digital interactions and education
- Validated outcomes reporting
- Seamless integration with primary care providers
For MSK, CMS focuses on improvements in pain, function, interference with daily activities, and standardized PROMs such as ODI, KOOS-JR, LEFS, QuickDASH and PROMIS-10.
Until ACCESS, Medicare beneficiaries had limited access to evidence-based virtual MSK programs—even as commercial plans embraced them. CMS is now explicitly elevating digital MSK into the medical benefit and aligning incentives for early, connected, continuous care.
As Eder highlighted in the November Op-Ed:
“Virtual MSK exploded in popularity, but without clinical integration and accountability, the patients who need it most still can’t access it.”
ACCESS is the federal response to that problem
What It Means for Patients
1. Easier Access to High-Quality MSK Care
Millions of older adults struggle with pain, mobility limitations, and transportation barriers. ACCESS removes those barriers by bringing MSK care directly to the home.
2. Faster Engagement, Better Outcomes
Research consistently shows that early and sustained PT improves outcomes and reduces downstream medical costs. Virtual programs accelerate both speed-to-start and ongoing adherence.
3. Low or No Out-of-Pocket Costs
ACCESS allows organizations to waive Medicare cost-sharing, making care more accessible for seniors on fixed incomes.
4. Integrated Care With Their Doctors
Under ACCESS, primary care providers automatically receive care updates and outcomes data—closing the loop between virtual MSK and in-person medical care.
What It Means for Providers and Health Systems
1. National Reimbursement for Digital MSK Care
For the first time, Medicare will pay for technology-enabled chronic MSK management.
2. Stronger Alignment With Primary Care
PCPs receive a co-management payment for reviewing patient progress, incentivizing engagement and coordination.
3. Better Data, Better Decisions
Validated PROMs and continuous monitoring produce richer clinical insight than sporadic clinic visits.
4. Reduced downstream costs
Higher adherence and better functional outcomes translate to fewer MRIs, injections, specialist visits, and unnecessary surgeries.
LainaHealth: Already Delivering What ACCESS Calls For
While ACCESS represents a new direction for CMS, it is the care model LainaHealth has been executing—and proving—for the last two years.
A Bundled, Technology-Enabled Model Ahead of Its Time
Since 2024, LainaHealth has offered a fully integrated virtual MSK care model combining:
- Licensed physical therapists
- AI-assisted real-time feedback
- Web-based telehealth on any device
- Continuous monitoring and two-way messaging
- Automated reminders and engagement tools
- Industry-leading PROM collection (>80% capture rate)
- Seamless integration with referring PCPs
This is not adjacent to ACCESS.
It is ACCESS—in action, for the past two years
Measurable Outcomes at Scale
Across thousands of referrals, LainaHealth has achieved:
- 2x engagement compared with traditional PT
- <50% of the cost of in-clinic physical therapy
- 66% average pain reduction
- 25 average sessions per episode
- 50%+ direct cost savings for payers
- Validated outcomes integrated directly into PCP workflows
These results mirror the very goals CMS built into the ACCESS framework.
Why ACCESS Represents the Future of MSK Care
The ACCESS Model validates a simple reality:
- Virtual MSK is healthcare—not wellness
- Outcomes should determine payment
- Technology improves access, adherence, and equity
- Integrated digital MSK models outperform episodic, clinic-only approaches
- Older adults deserve modernized care pathways that fit their lives
The November Op-Ed was a call to action for virtual MSK to be fully integrated, clinically accountable, and reimbursed like real medical care.
ACCESS is that vision—formalized.
And LainaHealth is positioned to lead its national implementation.
Partner With Us
As CMS prepares to launch ACCESS in 2026, health systems, CINs, ACOs, and payers have a unique opportunity to get ahead of the curve. LainaHealth already delivers the bundled, technology-enabled MSK model ACCESS is designed to promote—backed by real outcomes, strong engagement, seamless PCP integration, and proven cost savings.
If your organization is preparing for ACCESS or seeking a virtual MSK partner aligned with CMS’s emerging reimbursement framework, we invite you to connect with us.
Let’s build the future of MSK care—together.