Your ACCESS questions,
answered.

Who is ACCESS for? Which patients qualify?

The current model serves eligible Original Medicare patients with qualifying metabolic or cardiovascular conditions, chronic musculoskeletal pain, depression or anxiety. HealthyConnect confirms the clinical criteria, coverage and available services.

How do patients enroll?

Patients can enroll directly with HealthyConnect or connect through a practice, specialist, pharmacy or therapist. HealthyConnect checks eligibility, obtains consent and completes enrollment. An outside physician referral is not required.

What does the patient pay?

HealthyConnect ACCESS care is free to the patient. There are no copays for HealthyConnect ACCESS services, and qualifying clinician co-management also has no patient cost-sharing.

Does the patient keep their providers?

Yes. Patients keep their existing clinical relationships. HealthyConnect provides ongoing ACCESS care between visits and shares updates with the patient’s care team.

Can patients receive care across multiple tracks?

Yes, when they meet the clinical criteria for each track. Eligible clinicians may bill separate co-management when they complete distinct qualifying review and coordination for each track. Early CKM and CKM are alternative tracks.

What does HealthyConnect handle?

HealthyConnect handles eligibility and enrollment, ongoing ACCESS care and patient support, progress tracking and care updates. HealthyConnect bills Medicare directly for its ACCESS services and handles its model reporting.

What does our team do?

Connect appropriate patients with HealthyConnect. Eligible clinicians can review care updates, complete related care coordination, document that work and bill Medicare separately. Your organization does not need to become an ACCESS participant.

What information will we receive?

Care updates bring together relevant progress, available readings, medication information and follow-up needs. HealthyConnect agrees the delivery method with your team; supported EMR connections can bring this information into the clinical workflow.

How are clinical reviews paid?

Three qualifying reviews at the $30 national base amount total $90 per patient, per track, over 12 months. Qualifying initial onboarding adds $10. CMS requires at least five minutes for each review and coordination service.

First-year illustration includes qualifying onboarding revenue; the time denominator covers review and coordination only. Onboarding and administration take additional time. Actual payments reflect practitioner type, geography and applicable adjustments.

How does this fit existing programs and ACOs?

HealthyConnect reviews the patient’s current services to identify the appropriate care pathway and coordinate responsibilities. For Medicare Shared Savings Program and ACO REACH calculations, CMS anticipates no impact from ACCESS outcome-aligned payments in 2026–2027; those payments enter the calculations in 2028.

How do we get started?

Complete the one-page setup request. There is no fee to become a HealthyConnect referral partner. HealthyConnect coordinates onboarding, with a two-hour target for standard referral setup once the required information and contacts are available. EMR integration and billing enrollment have separate timelines.