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1Clear out junk files and repair common Windows errors2Fix the driver behind crashes, sound loss and screen glitches3Repair Windows errors before they cause bigger problemsBlue Shield of California expects to introduce chronic-care payment models in some commercial plans in 2027, but its design is still in development. The insurer has not said whether it will use Medicare’s payment amounts or which care organizations it will partner with. The plan is looking to a new federal experiment called ACCESS, which pays participating organizations for managing certain chronic conditions and ties full payment to measurable outcomes.
What Blue Shield has—and has not—announced
Blue Shield of California, which STAT reported serves 6 million members, told the outlet it expects to launch models similar to ACCESS in its commercial plans in 2027. The October 1, 2026 report did not establish that every commercial plan or member will be included. The insurer’s chief medical officer, Ravi Kavasery, said the company was still working out whether it would use CMS payment amounts and which organizations it would work with. [STAT]
That leaves important parts of the commercial proposal unresolved: the eligible conditions and members, payment rates, outcome measures, reporting rules, participating organizations, and enrollment process. The 2027 launch is an expectation, not a finalized operating plan.
What Medicare’s ACCESS experiment changes
ACCESS means Advancing Chronic Care with Effective, Scalable Solutions. The Centers for Medicare & Medicaid Services (CMS) describes it as a voluntary, 10-year Original Medicare model testing technology-supported chronic care. It began July 5, 2026, and is scheduled to run through June 30, 2036. CMS will evaluate quality and Medicare spending; the model’s expansion or permanence is not assured. [CMS model overview] [CMS technical FAQs]
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Under the traditional fee-for-service approach, Medicare pays for defined services and devices. CMS says those payment methods have not typically matched how technology-supported care is delivered. ACCESS instead tests recurring Outcome-Aligned Payments for managing a beneficiary’s qualifying condition. The full payment depends on achieving measurable clinical outcomes, such as improvement or control compared with the person’s starting point. CMS uses lowering blood pressure by 15 mmHg as an example of a target; it is not a universal target for every participant.
The approach is meant to pay for ongoing management rather than only a particular appointment, activity, or device. CMS will monitor performance and publish risk-adjusted outcomes, but the fact that the model has started does not establish that it has improved health or reduced spending.
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Who ACCESS covers—and how that differs from a commercial version
ACCESS applies to eligible people with Original Medicare. Medicare Advantage enrollees are not part of the federal model. A private insurer can separately offer a similar program to members in its own plans, but such a program is not automatically part of ACCESS and need not use CMS’s exact payment design.
The distinction matters for Blue Shield members: the planned commercial models would be the insurer’s own offering, with their own eligibility and terms. The available announcement does not establish which members could participate or whether Blue Shield will adopt CMS’s rates.
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Which conditions the federal model addresses
CMS’s initial ACCESS tracks cover four broad groups of conditions:
| Track | Conditions in the initial track |
|---|---|
| Early cardio-kidney-metabolic (eCKM) | Hypertension; dyslipidemia; obesity or overweight with a central-obesity marker; prediabetes |
| Cardio-kidney-metabolic (CKM) | Diabetes; chronic kidney disease stages 3a or 3b; atherosclerotic cardiovascular disease, including heart disease |
| Musculoskeletal (MSK) | Chronic musculoskeletal pain |
| Behavioral health (BH) | Depression and anxiety |
CMS says additional tracks for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorder, tobacco cessation, and a follow-on chronic musculoskeletal pain track start April 1, 2027. Current participants and applicants will not need to reapply for those new tracks. These are the federal model’s tracks; Blue Shield has not announced its commercial condition list.
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How care can be delivered under ACCESS
Participating organizations may combine clinician consultations with nutrition or exercise support, behavioral support, counseling, education, care coordination, medication management, diagnostic testing, and FDA-authorized devices or software. Care can be delivered in person, virtually, asynchronously, or through other clinically appropriate technology-enabled methods.
CMS requires participating organizations to be Medicare Part B-enrolled providers or suppliers, meet state licensing and applicable HIPAA and FDA requirements, and designate a physician clinical or medical director. These are requirements for ACCESS participants, not established requirements for Blue Shield’s future commercial partners.
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ACCESS is designed to complement, not replace, traditional care. Participating organizations share care plans and updates with primary-care and referring clinicians. Those clinicians may bill a co-management payment for reviewing updates and documenting coordination. Participation is voluntary for beneficiaries; they retain regular Medicare services and may continue seeing any Medicare provider.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What the ACCESS payer pledge means
Blue Shield of California is among the signatories to the ACCESS Payer Pledge. CMS said in its February 12, 2026 announcement, updated September 15, that signatories representing more than 165 million people across Medicare Advantage, Medicaid, and private coverage pledged to offer payment arrangements aligned with ACCESS core principles by January 1, 2028. Other listed signatories include Cigna, CVS Health, Humana, UnitedHealthcare, and regional Blue Cross and Blue Shield plans. CMS later added Baylor Scott & White Health Plan, TriWest Healthcare Alliance, and BCBS Rhode Island. [CMS payer pledge announcement]
The pledge is a commitment to offer aligned arrangements, not evidence that every signatory has already launched a program, or that all will use CMS’s rates. CMS said optional alignment resources—including sample provider-agreement structures, standardized billing codes, and FHIR-based reporting infrastructure—were in development in its announcement; that announcement does not establish their current availability.
What to watch as Blue Shield develops its plan
The federal model offers a reference point, but the commercial program’s details will determine what members and care organizations actually experience. The key unanswered questions are:
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- Which commercial plans, members, and conditions will be eligible?
- Will Blue Shield use CMS’s payment amounts, or set its own?
- Which care organizations will participate, and what clinical oversight will be required?
- How will the insurer define and measure outcomes, report results, and account for differences in patient risk?
- When will enrollment begin, and how will eligible members be notified?
CMS’s participant page listed more than 160 participating health care organizations as of its September 15, 2026 update, and notes that its directory may change. That gives a sense of the federal model’s provider participation, but it does not identify Blue Shield’s commercial partners. [CMS ACCESS participants]
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