On July 5th, CMS launched the ACCESS Model, a 10-year voluntary Medicare payment test paying for outcomes across four chronic care tracks. Alongside it, CMS shipped a full replication kit for the private payer market, and 14 of the largest health plans in the country signed the ACCESS Aligned Payer Pledge, covering 165 million member lives across Medicare Advantage, Medicaid, and commercial coverage, committing to offer ACCESS-Aligned arrangements by January 1, 2028. The surprise: the questions health plans will start asking vendors about outcome thresholds, defined care periods, and coordination with other providers start showing up in RFP language as early as this fall, whether or not the plan running the evaluation signed the pledge.

In this episode of the Upward Growth Podcast, Ryan Peterson walks through what ACCESS-Aligned means for health tech vendors selling into health plans, and what the evaluation question set will look like over the next 24 months. The episode goes one level deeper on why ACCESS-Aligned language lands in Q4 RFPs, unpacks the PE-side diligence patterns Ryan has been hearing over the last two weeks, and lays out what to do between now and the end of Q3 if your outcome story is not ready.

What you'll hear:

• What ACCESS-Aligned means, why the four principles are the anchor, and how the replication kit (sample provider agreement, standardized G-codes, CMS-hosted FHIR API) compresses private payer adoption timelines
• Why plans that never signed the pledge, and may not have Traditional Medicare business at all, end up asking the same questions in their vendor evaluations
• Which health tech categories just got elevated (cardio-kidney-metabolic, MSK, behavioral outcome measurement, care coordination, outcome measurement infrastructure), and which got deprioritized
• How ACCESS-Aligned reaches your buyer across Medicare Advantage (via the MA signatories), Medicaid (via Centene), and self-insured employer (via CVS Health)
• The 18-month timeline of milestones to watch, starting with when CMS publishes the sample provider agreement
• The specific instructions for vendors between now and the end of Q3, and why the repositioning window closes mid-2027

Read the full analysis in the Upward Growth newsletter: What the ACCESS Model Signals About Where CMS Wants Outcome-Based Chronic Care to Go

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

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Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com