The CMS ACCESS program went live on July 5. Your Medicare patients with chronic kidney disease, heart failure, and uncontrolled diabetes can now enroll in a managed care program without your referral and without your knowledge, as part of a program CMS has committed to running for the next 10 years.
That enrollment is happening right now, across your panel, with or without you.
What Changed on July 5
Before July 5, chronic care between visits was an unfunded gap. Patients drifted. Readings worsened. Nothing triggered a clinical response until the emergency department visit that replaced the appointment they missed.
CMS ACCESS closed that gap with a payment model built around what actually moves clinical outcomes. ACCESS participants and organizations enrolled directly with CMS now receive recurring payments to manage qualifying Medicare beneficiaries continuously between visits. Full payment depends on whether patients hit measurable targets: blood pressure controlled, HbA1c reduced, and kidney function stabilized. If the numbers do not move, the payment does not either.
July 5 marks the first time Medicare paid directly for outcomes rather than activities at this scale. It is not a pilot. It is a 10-year program, and it is running now.
What Your Patients Are Experiencing Right Now
Take a Medicare patient in your panel with stage 3 CKD and uncontrolled hypertension. As of July 5, more than 150 enrolled ACCESS participants can reach that patient directly. They do not need your referral. The patient attests to the participant of their choice, and the care program begins.
What happens next depends entirely on who that participant is.
With a clinical ACCESS participant, the patient receives a care coach within their first week, remote monitoring devices configured and ready to submit biometrics, medication reconciliation, and a care plan that adapts in real time based on how they are responding. When a reading falls outside the target range mid-week, a nurse escalates. When a specialist referral is needed, it routes back to their primary care physician. Every update flows back to the referring provider through their existing EHR.
With a consumer wellness app enrolled as an ACCESS participant, the patient receives an app. Their care plan lives outside your clinical record. Medication changes happen without your knowledge. Referrals may not return in-network. You find out something changed when the patient mentions it at their next appointment, or when a deterioration event brings them back through the emergency department.
Both are legal under ACCESS. CMS does not mandate clinical depth. The market determines quality.
What This Means for Your Co-Management Revenue
The ACCESS program creates a new, direct revenue stream for referring providers. CMS pays approximately $100 per patient per year for documented review and care coordination activity. No outcome risk. No change to FFS billing. Every office visit, specialist referral, lab, and procedure your practice bills today continues at standard rates.
But that revenue only flows through a structured relationship with an ACCESS participant who keeps you in the clinical loop. A participant that operates outside your EHR and does not deliver structured care updates does not generate co-management revenue for your providers. The patient is enrolled, the participant is paid, and your practice sees nothing.
For a practice with several hundred qualifying Medicare patients, the difference between a connected ACCESS partner and a disconnected one is a material annual revenue gap, compounding across a 10-year program.
What Innovaccer Delivers That Others Cannot
Innovaccer operates through Story Health Partners, its CMS-accepted physician entity that launched on July 5 as a first-cohort ACCESS participant, and absorbs all outcome risk. If enrolled patients miss clinical targets, Innovaccer loses revenue. Your practice does not.
Care delivery runs on Adaptive Program Intelligence™, the only ACCESS care management system that dynamically adjusts intervention intensity in real time based on each patient's engagement signals and clinical trajectory. Patients who are stable and engaged receive AI-led monitoring. Patients whose readings drift move into a hybrid coaching pathway. Patients with rising clinical risk receive high-touch clinical support and direct escalation. No fixed protocols. No one-size-fits-all approach.
Every medication change, care plan update, and clinical milestone flows back to the referring provider through bidirectional PCP communication and EHR-native workflows. Your clinical team retains full visibility into every decision made about their patients between visits.
Four guarantees apply to every health system partnering with Innovaccer: no outcome risk, no change to FFS billing, no financial burden to the patient, and no implementation cost.
The Window That Opened on July 5 Is Closing Daily
The patients most likely to benefit from ACCESS are the ones who have been falling through the gaps for years: high-risk, high-cost, chronically underserved between appointments. They began enrolling on July 5. They are enrolling today.
Every patient who attests to another participant is a clinical relationship that moves outside your workflow, a referral that may not return in-network, and a co-management revenue opportunity that goes elsewhere. That is not a risk that resolves itself over time. It compounds.
July 5 has passed. The question now is not whether to engage. It is how quickly a structured partnership can be in place before more of your eligible population enrolls elsewhere.
Book a call with Innovaccer's ACCESS team. We will show you how many of your Medicare patients are eligible, what co-management revenue looks like for your specific panel, and how the partnership model works. No commitment required.
