What ACCESS is

A CMS Innovation Center model that pays approved organizations to deliver technology-supported chronic care to people in Original Medicare. Payment is outcome-aligned: participants earn only when patients measurably improve.

Patients can enroll directly or by referral from their PCP. Referring practices don't join the model and take on no risk under it.

Why it matters to you

Behavioral health is one of the biggest undermanaged cost drivers in a Medicare panel, and one of the few levers most ACOs have never pulled. Your direct BH spend looks low because the spend is hiding in the ED.

If your ACO is already efficient, that's the point. The easy primary care levers are pulled. This one isn't.

For ACOs and value-based care

Close your behavioral health gap at zero cost and zero risk to your ACO

Refer eligible Traditional Medicare beneficiaries with clinically significant depression or anxiety to us. Unpacked by Limbic is a service that will deliver cognitive behavioral therapy (CBT) through scheduled telephone conversations with an AI voice agent, overseen by licensed clinicians supervising each patient’s care from beginning to end.

We find the patients in your panel, enroll them in your physician's name, and deliver a full course of talking therapy by phone. CMS pays us on measured outcomes, so you pay nothing.

By phone · Licensed clinician supervision · Measured on PHQ-9 and GAD-7

Across Medicare and Medicaid combined, 73% of providers are unable to accept new patients, mainly because their caseloads are full. Unpacked is designed to fill this void with immediate access to clinically-supported care.

Behavioral health is also one of the biggest undermanaged cost drivers in a Medicare panel, and one of the few levers most ACOs have never pulled.

What you get:

• No cost to the ACO. CMS pays us on outcomes. No PMPM, no per-visit fee.
• No new work for your PCPs. We work from claims data, so nothing waits on referrals.
• Attribution stays with you. Patients remain attributed to your practice.
• Care Updates back to your PCPs, who can bill the ACCESS co-management service.
• The measures CMS scores you on. CMS159 depression remission and CMS2 follow-up plan.
• Evidence behind it. Hospital costs fell 5% for treated depression patients in Medicare FFS and rose 10% for untreated.
  
  

And it doesn't count against your benchmark

Through PY2027, ACCESS payments sit outside your benchmark and performance year calculations

CMS anticipates no impact from ACCESS Outcome-Aligned Payments on ACO benchmark and performance year calculations for the Shared Savings Program and ACO REACH in 2026 and 2027. You can close a behavioral health gap now without the spend counting against your shared savings.

• 2026 and 2027: ACCESS payments outside your benchmark and PY calculations
• 2028 onward: included, and by then you have two years of avoided acute use to show for it
• Every year: no payment from the ACO, ever
  
  That's the window. This is why you should start now

How we propose working with you

We take on the full behavioural health burden for you

• You name us your preferred ACCESS partner for depression and anxiety
• We find the patients in your claims data who'd benefit most
• We enroll them in your physician's name, with sign-off and a patient opt-out window
• We deliver the care and measure it continuously on PHQ-9 and GAD-7
• Care Updates go back to your PCPs at baseline, milestones, escalation, and completion

We handle: identification, outreach, enrollment, therapy, clinical supervision, measurement, crisis escalation, reporting.

We need: preferred-partner designation, a preferred-provider agreement and BAA for claims access, physician sign-off on outreach.