What You'll Learn in This Article
ACCESS introduces a different conversation for Accountable Care Organizations. ACCESS places greater emphasis on whether organizations can consistently influence measurable patient outcomes.
That distinction has profound implications for how organizations think about care delivery. It shifts the question from "Did we perform the work?" to "Did the work actually change the patient's outcome?"
Care management is where strategy becomes execution. Many of the industry's current conversations have shifted toward workflow integration, operational scalability, personalized engagement, and human-AI collaboration.
The challenge is creating repeatable processes that transform information into action across large patient populations without overwhelming clinical teams.
The ACCESS Model has quickly become one of the most discussed developments in accountable care.
That is not surprising. Whenever CMS introduces a new payment approach, healthcare leaders immediately begin evaluating its implications for strategy, operations, and financial performance. What is more surprising is how much of the conversation has focused on understanding the model itself and how little has focused on the question many ACO leaders are quietly asking behind closed doors:
How do the economics of ACCESS actually compare to the value-based payment models we already know?
Most accountable care organizations have spent years building infrastructure around MSSP, care management programs, quality reporting, risk adjustment, and population health management.
They understand shared savings. They understand attribution. They understand benchmark performance and total cost of care.
Since CMS announced the ACCESS Model, organizations have been working to understand not only how the model functions, but also what it may signal about the future direction of value-based reimbursement.
ACCESS introduces a different conversation.
While many payment models evaluate whether organizations successfully manage populations, ACCESS places greater emphasis on whether organizations can consistently influence measurable patient outcomes. That distinction may appear subtle at first glance, but operationally it represents one of the most significant shifts we have seen in the evolution of value-based care.
As CMS continues pursuing its goal of having all Traditional Medicare beneficiaries connected to an accountable care relationship by 2030, understanding what ACCESS rewards and what it demands operationally may become just as important as understanding the model itself.
For years, healthcare organizations have operated within payment structures that rewarded participation, service delivery, documentation, or population-level performance.
Chronic Care Management rewards ongoing patient engagement and monthly service delivery. Transitional Care Management rewards successful post-discharge intervention. Shared savings models reward organizations that improve quality while reducing the total cost of care across a population.
ACCESS introduces a different layer of accountability.
Rather than focusing primarily on whether interventions occurred, the model increasingly focuses on whether those interventions resulted in measurable improvement. In other words, the question shifts from "Did we perform the work?" to "Did the work actually change the patient's outcome?"
That distinction has profound implications for how organizations think about care delivery.
Historically, healthcare organizations could build workflows around activities. Patients were contacted. Assessments were completed. Care plans were documented. Outreach was performed. Those activities remain important under ACCESS, but they become part of a larger equation. Activities alone are no longer sufficient. The ultimate objective is demonstrating meaningful clinical progress.
This is why comparing ACCESS directly to MSSP often misses the point.
MSSP primarily evaluates performance at the population level. As outlined by the Medicare Shared Savings Program, organizations are evaluated based on quality and total cost of care performance across attributed populations rather than specific disease-state outcomes.
ACCESS asks a different question.
Did specific patients experience measurable improvement in the conditions being targeted?
These models are not necessarily competing with one another. They are measuring different dimensions of value.
One evaluates how an organization performs across a population. The other evaluates whether interventions are producing meaningful clinical change at the individual patient level.
For ACO leaders, that distinction matters because it changes where operational attention must be directed
When discussing ACCESS, much of the industry attention has centered on payment methodology. Yet the greatest challenge associated with the model may have very little to do with payment itself.
The challenge is execution.
Most organizations already understand what drives better outcomes. Decades of evidence support care coordination, medication adherence, chronic disease management, behavioral health integration, patient engagement, and longitudinal care planning.
Few leaders would argue with the underlying clinical principles.
The difficulty lies in delivering those interventions consistently across thousands of patients while managing workforce shortages, competing priorities, fragmented workflows, and increasingly complex patient populations. That is where ACCESS becomes particularly interesting.
To succeed under ACCESS, organizations must identify the right patients, understand their risks, engage them consistently, monitor progress over time, intervene when barriers emerge, and adjust care plans based on patient response. Each of those activities requires infrastructure. Each requires workflow. Each requires coordination.
What became increasingly clear during recent industry discussions is that many organizations are arriving at the same conclusion: scalable value-based care requires scalable operational systems.
This reality helps explain why care management continues to receive so much attention across the accountable care landscape. The industry is gradually recognizing that care management is no longer a supporting program. It is becoming foundational infrastructure.
Consider two organizations managing a population of Medicare beneficiaries living with diabetes and hypertension.
Both organizations identify eligible patients. Both assign care managers. Both document outreach. Both perform assessments and maintain compliance with program requirements. Both can demonstrate that patient engagement activities occurred. On paper, the programs appear remarkably similar.
Under traditional care management models, both organizations may even generate comparable reimbursement. Under ACCESS, however, the comparison does not end with completed workflows.
Organization A successfully executes the process. Outreach occurs. Documentation is completed. Patients are contacted regularly.
Organization B executes the same process but also achieves measurable improvements. Medication adherence increases. Patients remain connected to primary care. Blood pressure control improves. Hemoglobin A1c levels decline. Emergency department utilization decreases. Patients become more engaged in managing their own conditions.
The difference between the two organizations is not activity. The difference is outcome.
This example highlights what may ultimately make ACCESS so consequential. The model pushes organizations beyond measuring whether work was completed and toward evaluating whether that work meaningfully changed a patient's clinical trajectory.
For many healthcare leaders, this is not a radical departure from the goals of value-based care. It is simply a more direct way of measuring whether those goals are being achieved.
One of the most interesting aspects of ACCESS is how it elevates the importance of care management.
Analytics can identify risk. Predictive models can prioritize patients. Artificial intelligence can surface opportunities that might otherwise go unnoticed. Yet none of those capabilities improve outcomes by themselves.
Technology can inform decision-making, but it cannot replace the work required to engage patients, coordinate care, address barriers, and influence behavior over time.
That is why organizations discussing ACCESS often find themselves talking about care management.
Care management is where strategy becomes execution. It is where data becomes action, where clinical insight becomes patient engagement.
This reality also explains why many of the industry's current conversations have shifted toward workflow integration, operational scalability, personalized engagement, and sustainable human-AI collaboration.
The organizations most likely to succeed under outcome-based payment models will not necessarily be those with the most sophisticated technology stacks. They will be the organizations capable of consistently translating insights into interventions and interventions into measurable results.
From our perspective at ThoroughCare, this is where the conversation becomes particularly important.
The challenge facing most ACOs is not a lack of data. Most organizations already possess more information than they can effectively operationalize. The challenge is creating repeatable processes that transform information into action across large patient populations without overwhelming clinical teams.
As payment models continue moving closer to outcomes, that capability becomes increasingly valuable.
The most important question surrounding ACCESS may not be whether organizations choose to participate. The more important question is whether they possess the operational infrastructure required to succeed as payment becomes increasingly tied to outcomes rather than activities.
That distinction extends far beyond a single CMS model.
Across healthcare, the direction of travel is becoming increasingly clear. Organizations are being asked not only to demonstrate that services were delivered, but also that those services produced meaningful improvement in patient health. That trajectory continues to be reinforced through initiatives emerging from the CMS Innovation Center and its broader vision for accountable care.
Success will increasingly belong to organizations capable of connecting patient engagement, care management, clinical workflows, data, and operational execution into a unified strategy.
ACCESS may be a new payment model, but what it is really testing is something much larger: whether healthcare organizations can consistently translate intention into outcomes.
Centers for Medicare & Medicaid Services (CMS). ACCESS Model. https://www.cms.gov/priorities/innovation/innovation-models/access
Centers for Medicare & Medicaid Services (CMS). Medicare Shared Savings Program.
https://www.cms.gov/medicare/payment/fee-for-service-providers/sharedsavingsprogram
CMS Innovation Center. Innovation Models and Value-Based Care Initiatives.
https://www.cms.gov/priorities/innovation
National Association of ACOs (NAACOS). Policy and Payment Reform Resources.
https://www.naacos.com
American Journal of Managed Care (AJMC). Value-Based Care and ACCESS Model Coverage
https://www.ajmc.com
Dan Godla is Founder and Chief Strategy Officer at ThoroughCare. He works closely with accountable care organizations, provider groups, and value-based care leaders across the country to improve care management operations, patient engagement, and performance across risk-based payment models. His work focuses on helping organizations translate strategy into scalable execution through technology-enabled care management and longitudinal patient engagement.