START WITH SIX ESSENTIAL TERMS
The basics of ACCESS and HealthyConnect.
ACCESS and HealthyConnectPayment and coverageRelated care servicesOrganizations and clinical rolesData and deployment
Plain-language explanations for this resource center. Program eligibility and billing depend on the applicable official guidance and payer terms.
Who does what?
CMS
Defines the ACCESS model and payment requirements.
HealthyConnect
Delivers its ACCESS care and bills Medicare directly.
Partner clinicians
Keep their clinical relationships and perform qualifying reviews and coordination.
Patients
Choose to enroll, engage in care and keep their existing providers.
Easy to mix up
| Terms | The distinction |
|---|---|
| ACCESS participant / referral partner | The participant delivers ACCESS care; the referral partner introduces patients. |
| OAP / CMP | Payment for ACCESS care and outcomes / payment for qualifying review and coordination. |
| MyHealthyConnect / Orchestrate | The patient connection / the clinician-facing workflow. |
| Pledged population / eligible patients | Potential reach across payers / people meeting applicable coverage and clinical criteria. |
ACCESS and HealthyConnect
- HealthyConnect / HealthyConnect
- HealthyConnect (HealthyConnect) is part of the Remote Care Partners organization. HealthyConnect delivers its ongoing ACCESS care, supports patients and coordinates with their existing providers. Meet HealthyConnect ↗
- Remote Care Partners
- The organization behind HealthyConnect and its connected care offering. HealthyConnect is the care brand used throughout this resource center. Meet HealthyConnect ↗
- Continuous care
- HealthyConnect’s term for ongoing clinical support, connected information and coordinated action between visits, delivered alongside the patient’s existing providers. See HealthyConnect’s care model ↗
- Referral partner
- An organization that introduces patients to HealthyConnect. HealthyConnect delivers its ACCESS care; eligible partner clinicians may separately provide qualifying co-management. See partner roles ↗
- Clinical review
- A clinician’s assessment of a patient’s care update. A qualifying co-management service includes related care coordination and required documentation. See review payments ↗
- Care coordination
- Clinical work that connects the people and next steps in a patient’s care, such as reconciling medications or establishing follow-up instructions. See a care update ↗
- Patient cost-sharing
- The portion of a covered service’s cost paid by the patient, such as a deductible or coinsurance. HealthyConnect offers its ACCESS care with no patient charge. See patient answers ↗
- Outcome measure
- A defined way to assess a patient’s health or progress, such as blood pressure or a reported measure of pain or function. See clinical tracks ↗
- ACCESS
- Advancing Chronic Care with Effective, Scalable Solutions: the CMS model for outcome-aligned, technology-supported chronic care. See how ACCESS works ↗
- ACCESS participant
- A care organization accepted into the CMS model to deliver its services. A payer signatory is a different role. See who operates ACCESS ↗
- MyHealthyConnect
- HealthyConnect’s patient-facing connection to its services; account creation and ACCESS enrollment are separate steps. Explore MyHealthyConnect ↗
- Orchestrate / EMR ribbon
- HealthyConnect’s clinician-facing workflow within a supported medical record environment, where deployed. See the clinician workflow ↗
- ACCESS Care Update
- Clinical information shared by an ACCESS care organization to support coordination with the patient’s other clinicians. See review payments ↗
- Clinical track
- A grouping of conditions managed under a defined ACCESS care and outcome framework. See clinical tracks ↗
- eCKM
- Early cardio-kidney-metabolic: an ACCESS track focused on specified early cardiometabolic risks. See clinical tracks ↗
- CKM
- Cardio-kidney-metabolic: an ACCESS track addressing specified established metabolic, kidney and cardiovascular conditions. See clinical tracks ↗
- MSK
- Musculoskeletal: relating to muscles, bones, joints and associated structures; ACCESS includes a chronic pain track. See expansion and payer pledges ↗
- BH
- Behavioral health: mental health and related care; the initial ACCESS BH track addresses depression and anxiety. See the behavioral health package ↗
Payment and coverage
- OAP — Outcome-Aligned Payment
- Payment to an ACCESS participant linked to the model’s care and outcome requirements. See how ACCESS works ↗
- CMP — Co-Management Payment
- Payment for qualifying review of an ACCESS update and related care coordination. A referral alone does not earn it. See review payments ↗
- Payer pledge
- A stated commitment to offer aligned payment arrangements. It is not a patient benefit determination or a HealthyConnect contract. See expansion and payer pledges ↗
- Original Medicare
- The federal Medicare coverage option comprising Part A and Part B. See Medicare coverage answers ↗
- MA — Medicare Advantage
- Medicare coverage through a Medicare-approved private plan; plan-specific rules and contracts matter. See Medicare coverage answers ↗
- Covered lives / represented population
- People counted within a payer population. This differs from clinically eligible, contracted, enrolled and active patients. See expansion and payer pledges ↗
- PMPM
- Per member per month: a unit used to express recurring revenue, payment or cost. See review payments ↗
- Revenue less modeled review labor
- Illustrative revenue minus modeled review labor expense. This measure is not net profit. See review payments ↗
- HCPCS / G-code
- Healthcare Common Procedure Coding System; G-codes identify certain services for claims. A code alone does not establish eligibility. See review payments ↗
- PPS / AIR
- Prospective Payment System / All-Inclusive Rate: payment-framework terms relevant to FQHCs and RHCs. Find your organization’s package ↗
Related care services
- CCM — Chronic Care Management
- Ongoing coordination and management for qualifying patients with multiple chronic conditions. Compare care services ↗
- RPM — Remote Patient Monitoring
- Remote use of physiologic measurements, such as blood pressure, to inform patient management. Compare care services ↗
- RTM — Remote Therapeutic Monitoring
- Remote monitoring of treatment-related information, such as adherence or response to therapy. Compare care services ↗
- APCM — Advanced Primary Care Management
- A Medicare primary-care management service framework. It has its own eligibility, service and billing rules. Compare care services ↗
- TCM — Transitional Care Management
- Care management during a qualifying transition from a facility to the community. Compare care services ↗
Organizations and clinical roles
- PCP
- Primary care physician or provider: the clinician serving as a usual source of general medical care. See the primary care package ↗
- FQHC
- Federally Qualified Health Center: a qualifying community-based provider with a distinct Medicare payment framework. See the FQHC package ↗
- RHC
- Rural Health Clinic: a certified provider serving rural communities under a distinct Medicare framework. See the RHC package ↗
- IPA
- Independent Practice Association: an organization through which independent practices may coordinate services or contracting. See the IPA package ↗
- CIN
- Clinically Integrated Network: providers organized around shared clinical processes and performance improvement. See network partnerships ↗
- ACO
- Accountable Care Organization: providers working together under arrangements that hold them accountable for quality and spending. See network partnerships ↗
- NP
- Nurse practitioner: an advanced practice clinician whose work depends on licensure, scope and applicable program rules. See the primary care package ↗
Data and deployment
- EHR / EMR
- Electronic health record / electronic medical record: the clinical system used to record and retrieve patient information. See the clinician workflow ↗
- FHIR
- Fast Healthcare Interoperability Resources: a standard for exchanging healthcare information electronically. See the clinician workflow ↗
- SMART on FHIR
- A framework that helps authorized applications work with health data and supported clinical systems. See the clinician workflow ↗
- Patient journey
- The relevant sequence of care events and changes over time, including what happened since the previous visit. Explore MyHealthyConnect ↗
- AI-assisted summary
- A software-generated synthesis of available information for human review; it may be incomplete or incorrect. Explore MyHealthyConnect ↗
- Enrollment / alignment
- Enrollment joins a patient to a service; alignment associates that patient with the applicable participant and track. Explore MyHealthyConnect ↗
- Activation
- HealthyConnect planning term for when a patient has completed the steps needed to begin the agreed care workflow. Explore MyHealthyConnect ↗
- Escalation
- Routing a clinical or operational issue to a named person who can act within the agreed response process. See setup steps ↗
HealthyConnect product and workflow definitions describe the approach used in these materials. They do not imply that every integration or service is available in every deployment.