April 30, 2026
The U.S. healthcare system continues its steady shift toward value-based care—where outcomes matter more than volume. Two emerging federal initiatives, the CMS ACCESS Model and the MAHA ELEVATE Initiative, offer a clear signal of where healthcare is heading next.
While neither program directly reimburses exercise professionals today, both reinforce a powerful and growing reality: physical activity is becoming central to how chronic disease is managed—and paid for.
Here's what exercise professionals, credentialing organizations, and industry leaders need to know.
A System in Transition: From Volume to Outcomes
At the highest level, both initiatives reflect a broader transformation already underway:
- Healthcare payments are increasingly tied to measurable outcomes
- Chronic disease management is shifting toward long-term, population-based care
- Prevention and lifestyle interventions are becoming core—not optional—components of care
For the exercise profession, this is not a distant trend. It's an emerging opportunity.
The CMS ACCESS Model: Paying for Outcomes, Not Services
The CMS Innovation Center's ACCESS Model, launching in July 2026, introduces a new approach to managing chronic disease populations.
Instead of billing per service, participating organizations receive annual, per-patient payments tied to performance outcomes.
The model focuses on four major clinical areas:
- Cardio-kidney-metabolic conditions
- Early-stage metabolic disease
- Musculoskeletal conditions
- Behavioral health
These are all areas where physical activity plays a critical role.
However, there's an important nuance:
The model does not currently include direct reimbursement for exercise professionals or physical activity programs.
Instead, funding supports infrastructure such as:
- Care coordination
- Remote monitoring
- Clinical integration
- Longitudinal chronic care management
In other words, the system is paying for outcomes—but not yet specifying who delivers the interventions that drive those outcomes.
Why That Matters for Exercise Professionals
Even without direct reimbursement, ACCESS creates indirect opportunity.
Healthcare organizations participating in this model will need to improve outcomes like:
- Blood pressure control
- Weight management
- Glycemic control
- Musculoskeletal function
- Mental health outcomes
All of these are strongly influenced by structured, evidence-based physical activity.
That creates a gap—and a potential entry point.
MAHA ELEVATE: A Glimpse Into Prevention-Driven Care
The MAHA ELEVATE Initiative, also from the CMS Innovation Center, takes things a step further.
While details are still emerging, early indications suggest a focus on:
- Chronic disease prevention
- Lifestyle medicine
- Nutrition and metabolic health
- Behavioral health
- Physical activity and coaching
- Digital health and remote monitoring
Unlike ACCESS, which focuses on managing existing conditions, ELEVATE signals a stronger push toward preventing disease altogether.
The formal RFP has not yet been released, but the direction is clear:
Healthcare is expanding beyond treatment—and into behavior change.
The Big Picture: "Exercise as Medicine" Is Moving Closer to Reality
Taken together, these initiatives reinforce a concept long championed by CREP and USREPS:
Exercise is not ancillary to healthcare, it is foundational.
We are seeing:
- Greater emphasis on lifestyle-based interventions
- Growth of multidisciplinary care teams
- Increased demand for measurable, evidence-based outcomes
As these models evolve, healthcare systems will need partners who can deliver consistent, scalable, and clinically relevant physical activity interventions.
Where the Opportunities Will Emerge
Participation in these models is unlikely to happen at the individual professional level—at least initially.
Instead, opportunities will likely develop through:
- Partnerships with healthcare systems
- Integration into population health programs
- Collaboration with digital health and remote monitoring platforms
- Alignment with lifestyle medicine and referral-based models
In short: integration, not isolation.
What This Means for the USREPS Community
For credentialed exercise professionals and member organizations, the implications are significant:
1. The bar for credibility is rising
Healthcare integration requires standardization, quality, and trust.
2. Outcomes will matter more than ever
The ability to demonstrate impact on health metrics will be critical.
3. Partnerships will define success
Working alongside healthcare providers—not outside of them—will unlock opportunity.
Looking Ahead
These federal initiatives should not be viewed as immediate revenue opportunities for the fitness industry.
Instead, they are something more important:
Signals of policy direction.
They point toward a future where:
- Physical activity is embedded in care pathways
- Exercise professionals are part of coordinated care teams
- Credentialing plays a central role in workforce recognition
And that future is getting closer.
The Role of CREP and USREPS
As this landscape evolves, CREP and USREPS will continue to:
- Monitor federal developments
- Evaluate implications for the workforce
- Support integration into healthcare models
- Advocate for recognition of qualified exercise professionals
Because as healthcare continues to change, one thing is becoming increasingly clear:
The system will need professionals who can deliver safe, effective, and measurable physical activity interventions.
