Medicare ACCESS Organizations
Deliver and prove outcomes — your payment depends on it.
The challenge and the solution.
The challenge
Medicare ACCESS participants get 50% of their per-beneficiary payments withheld until they demonstrate measurable clinical outcomes across their enrolled cohort. Most care organizations don't have the infrastructure to track daily patient engagement, capture outcome metrics between visits, or aggregate performance data at the cohort level required for reconciliation.
The OpenCareBridge solution
OpenCareBridge gives ACCESS organizations the patient-facing engagement layer and care team oversight tools they need to hit outcome targets at scale. Patients follow condition-specific care guides in Guardian, care navigators monitor adherence in Wellness, and licensed clinicians review real-time metrics in Pro — with cohort-level outcome reporting built for reconciliation.
Workflow overview.
Enroll eligible beneficiaries
Add Medicare beneficiaries into program tracks (eCKM, CKM, MSK, or BH) through Enroll with eligibility verification and cohort segmentation.
Assign condition-specific care guides
Clinicians create track-specific care guides in Pro — blood pressure targets, HbA1c goals, pain tracking, or mood/function PROs — delivered directly to the patient's Guardian app.
Monitor adherence and capture outcome data
Patients log daily metrics in Guardian. Care navigators review engagement signals in Wellness and escalate deviations to the clinical team before thresholds are missed.
Aggregate outcomes for reconciliation
Pro surfaces cohort-level outcome attainment across all enrolled beneficiaries, giving your Clinical Director the data needed for ACCESS Model annual reconciliation.
Products that matter for medicare access model participants.
Guardian
MVP PreviewThe patient-facing mobile care guide.
Pro
MVP PreviewThe licensed professional portal.
Wellness
MVP PreviewThe workspace for health coaches, wellness teams, and support users.
Enroll
AvailableThe intake and enrollment layer.
Home Tests
Coming SoonThe at-home testing and lab coordination layer.
How it flows in practice.
- Clinical DirectorConfigures track-specific care plans and outcome thresholds in Pro
- PatientFollows care guide in Guardian — daily metrics, routines, and self-reported outcomes
- Care navigatorMonitors adherence and escalates threshold deviations in Wellness
- Clinical DirectorReviews cohort outcome attainment and reconciliation reporting in Pro
Designed for compliance-safe workflows.
OpenCareBridge supports ACCESS Model requirements for clinician-guided, coordinated care. Care navigators operate within wellness-only permission boundaries; clinical thresholds, escalation decisions, and outcome attestations remain with your licensed Clinical Director. Data reporting complies with HIPAA and CMS API reporting requirements.
What organizations typically see.
Daily patient engagement data across all four ACCESS clinical tracks
Real-time outcome metric capture between visits — reducing reconciliation risk
Cohort-level performance visibility for Clinical Directors and program managers
Scalable care navigator workflows to support large beneficiary populations
Ready to see OpenCareBridge in action?
Request a demo tailored to your use case and team size.