CMS ACCESS Model
ACCESS Yield Calculator
What a panel could collect under ACCESS, computed the way CMS pays. Only Medicare fee-for-service patients count. CMS pays 80% of the rate and half of that waits on outcomes. A first pass your finance team can check against real numbers.
Estimate what your panel could collect
First 12-month care period, all four tracks
Half monthly, half on attainment.
If every patient stays aligned at the same attainment rate. MSK pays once.
Whole patients after the control-group draw
Estimate only, not a guarantee of payment. Assumes an accepted ACCESS participant and patients who consent to align and complete baseline reporting. DisEASE LLC is not affiliated with or endorsed by CMS. For each enrolled patient, these payments replace the participant's fee-for-service billing. They do not add to it.
When the money arrives
The chart adds up what your panel collects month by month over the first two years. The flat stretch from month seven is the withheld half waiting on outcomes. The step at month 12 is CMS releasing it, scaled to your attainment rate. Month 24 does the same for year two. Each release is drawn at the close of its period. In practice the final measures are due about two months after the period ends, so each step lands later than drawn.
$10,128 a month for six months, then nothing until CMS releases the withheld half ($60,768 at your rate). Year two repeats the pattern at half the rate and adds $69,528. At your rate nothing is forfeited, so the chart shows one line.
What attainment is worth
The withheld half is the only number clinical outcomes move.
$2,431 for each percentage point of attainment below 50%, down to the floor at 25%. $60,768 of your panel's first-period Medicare portion rides on outcomes.
A patient counts toward attainment only when every measure that applies to them is reported on time and each one is at target or improved by the minimum. Miss one measure or report late and that patient counts against the rate. So does a patient who stops coming in. CMS pays the Medicare portion times attainment divided by 50% and takes the shortfall out of the withheld half. At 40% you collect 80% of the Medicare portion. At 25% or below you keep only the monthly payments.
How a panel reaches the rate
Blood pressure, A1c, LDL, and weight are the four measures behind the CKM and eCKM withhold. Each moves with medication choice and dosing, one patient at a time. DisEASE's pharmacist-certified deterministic rules rank those medication changes for each workup and cite every claim. Blood pressure and A1c are covered today. LDL and weight are in development.
What each patient must reach
The numbers a CKM or eCKM patient must reach or improve
Two ways to pass each measure: at target or improved enough from baseline.| Measure | CKM | eCKM | DisEASE |
|---|---|---|---|
| Systolic BP | Under 130 mmHg, or at least 15 mmHg below baseline. Judged on systolic only. | Same as CKM | Covered today |
| A1c | Patients with diabetes: under 7.5%, or at least 1.0 point below baseline. | Patients with prediabetes: under 6.5%. No improvement alternative. | Covered today |
| LDL | Under 100 mg/dL, or under 70 mg/dL with ASCVD, or at least 30 mg/dL below baseline. | Under 100 mg/dL, or at least 30 mg/dL below baseline. | In development |
| Weight | BMI under 30 with no more than 5% weight gain, or at least 5% weight loss over the period. | Same as CKM | In development |
| eGFR and uACR | Reported at baseline for diabetes and CKD patients. A lab-measured (quantitative) uACR is required. No target to meet. | Not eCKM measure | Covered today |
Only the measures for conditions a patient has apply. A patient without ASCVD is not held to the 70 mg/dL line.
What turns a controlled patient into a miss
- Every aligned patient needs valid baselines for all required measures within 60 days of alignment: blood pressure, weight, A1c and LDL, plus eGFR and uACR for patients with diabetes or CKD. Miss that window and CMS drops the patient from the track.
- Quarterly values do not set payment, but on-time quarterly reporting counts toward attainment and is required to keep billing. Each quarterly report is due 70 to 110 days after the prior submission. The end-of-period submission decides payment. It is due by day 425, about 14 months after the period starts.
- Blood pressure and weight readings must be within 15 days and labs within one to two years. Patient-reported values do not count, except weight.
- Blood pressure must come from a validated upper-arm cuff that sends timestamped, verifiable readings. Manual entry does not count, and each submission must average at least three readings.
- A reading that is late, missing, or out of window scores the same as a missed target.
Other tracks. MSK pays once per patient for measured improvement in a pain and function score for the affected site. BH pays when PHQ-9 or GAD-7 stays under 10 or drops by 5 points (PHQ-9) or 4 points (GAD-7).
Track by track
Patient counts and whole dollars. Initial Period is a patient's first 12-month period off target. It pays the full rate. Follow-On is every later period and any patient already at target. It pays half the rate. Each following year assumes every patient stays aligned. MSK pays once per patient, so it has no Follow-On and no following year. BH is behavioral health (depression or anxiety).
| Track | Aligned patients | Initial Period (full rate) | Follow-On (half rate) | Medicare portion | Paid in months 1 to 6 | Collected at your rate | Each following year |
|---|---|---|---|---|---|---|---|
| CKM | 122 | 85 | 37 | $34,776 | $17,388 | $34,776 | $20,496 |
| eCKM | 292 | 204 | 88 | $71,424 | $35,712 | $71,424 | $42,048 |
| MSK | 24 | 24 | N/A | $3,456 | $1,728 | $3,456 | N/A |
| Behavioral Health | 97 | 68 | 29 | $11,880 | $5,940 | $11,880 | $6,984 |
| All tracks | 535 | 381 | 154 | $121,536 | $60,768 | $121,536 | $69,528 |
CKM and eCKM hold $53,100 of the $60,768 withheld, 87%. Those are the tracks where blood pressure, A1c, LDL, and weight decide the release.
Why the estimate is lower than rate times panel
Start with the published rate times every qualifying patient. Four CMS rules bring it down, in the order they apply. All four come from the CMS payment schedule for 2026 to 2027 and the ACCESS application guidance from February 2026.
Only Medicare fee-for-service patients count
ACCESS Outcome-Aligned Payments are Medicare Part B payments, so Medicaid-only and Medicare Advantage patients are outside the model. Count them and each figure below is inflated.
On this panel: 540 of 1,800 attributed patients.
One in ten alignment attempts goes to a control group
First-year randomization is 90:10 at the beneficiary level. Control patients cannot be aligned for 12 months. CMS may adjust or drop the ratio later.
On this panel: 535 track alignments after the draw (CKM 122, eCKM 292, MSK 24, Behavioral Health 97). A patient in more than one track counts in each.
The full rate is per patient and only while that patient is off target
An Initial Period is one 12-month care period for a patient who is off target on at least one measure and new to the participant in that track. A patient already at target aligns straight into Follow-On at half the rate. There is no panel-wide first year at the full rate.
On this panel: 381 in an Initial Period at the full rate, 154 in Follow-On at half.
The published rates are allowed amounts. Medicare pays 80%
The published $420 and $360 are annual allowed amounts. Medicare pays 80%. The 20% coinsurance may be waived uniformly. This estimate assumes it is unless you count it in the panel inputs. Monthly payments and the withhold cap are both computed on the Medicare portion.
On this panel: $151,920 allowed, $121,536 after the 20% coinsurance.
CMS pays half of that ($60,768) monthly. The other half ($60,768) waits on outcomes. At 50% attainment $60,768 comes back and the estimate is $121,536.
Formula, defaults, and what is left out
Medicare FFS patients = attributed patients x Medicare FFS share Aligned, per track = Medicare FFS x track share x 0.90 if the control-group draw is on Initial / Follow-On = aligned x (1 - already at target) / aligned x already at target Allowed, first period = Initial x rate + Follow-On x rate/2 (MSK: aligned x $180, no Follow-On) Medicare portion = Allowed x 0.80 (x 1.00 if coinsurance counted) Paid monthly = Medicare portion x 0.50 Payment factor = attainment / 50%, never below 0.50 or above 1.00 Collected = Medicare portion x factor Each following year = aligned x rate/2 x 0.80 x factor (x 1.00 if coinsurance counted; MSK: 0)
- Attributed patients, 1,800
- A commonly cited single-PCP panel. For a group, enter the combined attributed count and the provider count. scienceinsights.org
- Medicare FFS share, 30%
- No national source. Use your panel's Parts A and B count, including dual-eligibles.
- CKM share, 25%
- Diabetes, ASCVD, and CKD prevalence. ADA · U.S. Pharmacist · NIDDK
- eCKM share, 60%
- Hypertension, hyperlipidemia, obesity, and prediabetes prevalence. CDC NCHS Data Brief 540. This figure overlaps heavily with CKM. A patient aligns to CKM or eCKM, never both, so refine both shares from your own data.
- MSK share, 5%
- New and persistent chronic pain. NCCIH
- BH share, 20%
- Depression and anxiety prevalence. CDC NCHS FastStats.
- Already at target, 30%
- No national source. Pull the share of qualifying patients who already have every required measure at target from your registry.
- Rates and mechanics
- CMS ACCESS Model Payment Amounts and Performance Targets (effective Jul 5, 2026 to Dec 31, 2027) and the ACCESS Request for Applications (Feb 12, 2026). Program overview at cms.gov.
Not modeled
- The Substitute Spend Adjustment. CMS expects at least 90% of care for the qualifying condition to be billed through ACCESS rather than fee-for-service. Falling short reduces payment by up to 25%. CMS applies the larger of this reduction and the attainment reduction, not both.
- The $15 rural add-on per CKM or eCKM patient in an Initial Period, and the 5% discount on the lower-paying track when one patient is aligned in two tracks.
- Control-group patients returning after 12 months, patients auto-unaligned for missing baseline, and attrition.
- Medicare Advantage contracts, Stars, MIPS, and readmission programs reward the same blood pressure, A1c, and LDL control. None of that money is counted here.
Calculator revision 2026-09-18. Rates and thresholds as published in the CMS ACCESS Payment Amounts and Performance Targets (effective Jul 5, 2026 to Dec 31, 2027) and the ACCESS Request for Applications (Feb 12, 2026). CMS may revise.
About the CMS ACCESS Model
A voluntary, 10-year model from the CMS Innovation Center that pays for outcomes in chronic care.
ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) began July 5, 2026. It pays ACCESS participants, which are Medicare-enrolled organizations, for technology-supported chronic care of enrolled Medicare fee-for-service patients. CMS calls these Outcome-Aligned Payments. A practice that becomes a participant gives up fee-for-service billing for its enrolled patients. Practices that refer patients instead can bill a separate Co-Management Payment. There are four tracks: cardio-kidney-metabolic (CKM), early CKM (eCKM), musculoskeletal (MSK), and behavioral health (BH). CMS has announced heart failure, COPD, substance use disorder and tobacco cessation tracks starting April 1, 2027.
Half of each payment arrives monthly. The other half is held until reconciliation and released in proportion to how many aligned patients meet their measures. Apply before October 1, 2026 and you are considered for the January 1, 2027 cohort. New cohorts start each quarter through July 1, 2033.
Read the CMS program overviewPayment amounts and performance targets (PDF)
Where DisEASE fits
Half of every ACCESS payment rides on measure attainment. The measures move when each patient's medications are chosen and dosed well at the point of care. That is the work DisEASE does.
CMS pays the Medicare portion times your attainment rate divided by 50%, less what it already paid monthly. At 50%, $60,768 comes back and $0 is forfeited.
The share of aligned patients who report on time and meet every required measure.
- Blood pressureCovered today
- A1cCovered today
- LDL cholesterolIn development
- WeightIn development
- Pharmacist-certified deterministic rules rank the medication options for the measure.
- Dr. EASE explains the ranking and cites its sources.
- The clinician decides. Each patient brought to target counts toward attainment.
CMS has announced a heart failure track starting April 1, 2027. Current participants do not need to reapply. CMS has not published its measures or rates yet, so this estimate does not include it.
Talk to us about ACCESS
Questions about ACCESS, or about where DisEASE fits in your panel? Send us a note and we reply by email.
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Terms used on this page. CKM is the cardio-kidney-metabolic track (diabetes, ASCVD, or CKD). eCKM covers hypertension, hyperlipidemia, obesity, or prediabetes in patients not already counted in CKM. MSK is chronic musculoskeletal pain. BH is behavioral health (depression or anxiety). An aligned patient's first 12-month care period in a track is the Initial Period. Each later period is Follow-On, paid at half the rate. CMS pays half of the Medicare portion monthly. It holds the other half (the withhold) until reconciliation after the care period. It then pays the Medicare portion times the attainment rate divided by 50%. Any shortfall comes out of the withhold. The attainment rate is the share of aligned patients who report on time and meet every required measure.
DisEASE LLC is not an ACCESS participant, does not process ACCESS payments, and is not affiliated with or endorsed by CMS. Figures on this page are estimates and not a guarantee of payment. They are not financial, legal, or reimbursement advice.