ACCESS Model Position Paper: The Role of Case Management 

As the Centers for Medicare & Medicaid Services (CMS) launches the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, healthcare organizations across the country are preparing to test new approaches to technology-supported chronic care management. The ACCESS Model represents a significant shift toward outcome-based care, leveraging digital tools, interdisciplinary collaboration, and patient engagement to improve health outcomes for Medicare beneficiaries living with chronic conditions. 

To help inform implementation efforts, CMSA has developed Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model: The Role of Case Management, a position paper that highlights the critical contributions of professional case managers within this innovative care delivery framework. The paper demonstrates how case managers serve as the connective link between technology, providers, patients, caregivers, and community resources—ensuring that technology-enabled care remains coordinated, equitable, and person-centered.  

Professional case managers have long been leaders in care coordination, transitions of care, patient advocacy, behavioral health integration, and addressing social drivers of health. As organizations participating in the ACCESS Model begin implementation, this position paper illustrates how these competencies directly support the model's goals of improving outcomes, advancing health equity, reducing avoidable utilization, and empowering patients to better manage their health.  

The paper also provides practical guidance on workforce competencies, organizational readiness, technology integration, equity considerations, and evaluation measures that can help healthcare organizations successfully operationalize the ACCESS Model. Most importantly, it reinforces a central message: while technology can expand access and improve efficiency, meaningful outcomes are achieved through the expertise, judgment, and coordination provided by professional case managers.  

We invite healthcare leaders, case managers, policymakers, and participating organizations to explore this important resource and consider how professional case management can help transform the promise of the ACCESS Model into measurable improvements in patient outcomes, experience, and equity.