For practices in the CMS ACCESS program
See where every ACCESS patient stands, measure by measure.
Fivefold scores each of your patients against the program's kidney and cardiometabolic measures, and shows the whole panel in one view, so your team can see who needs attention first, and on which measure.
Talk to usNo commitment. Write to us and Triangle's team will reply.
Fivefold is made by Triangle. Your message goes to Triangle's team.
- HIPAA compliant, with a public Trust Center
- Listed in the Medicare App Library
- No drug maker, lab or hospital pays Triangle
The five measures
- 01Blood pressuremmHg
- 02Weight and BMIkg/m²
- 03HbA1c%
- 04LDL cholesterolmg/dL
- 05Kidney functioneGFR
Scroll the table sideways to see every measure.
| Patient | Blood pressuremmHg | Weight and BMIBMI, kg/m² | HbA1c% | LDLmg/dL | Kidney functioneGFR, change since last |
|---|---|---|---|---|---|
| R.M.67 | 128/78 on track | 29.1 on track | 6.8 on track | 92 on track | 71 stable on track |
| D.K.58 | 146/92 action | 34.6 watch | 8.1 watch | 131 action | 64 down 4% on track |
| L.T.72 | 126/76 on track | 26.2 on track | Not scored | 88 on track | 48 down 12% watch |
| J.O.61 | 134/86 watch | 31.0 watch | 6.9 on track | No data | 82 stable on track |
| S.P.69 | 124/74 on track | 24.8 on track | Not scored | Not scored | 58 stable on track |
| W.H.55 | No data | 38.2 action | 9.4 action | 156 action | 89 stable on track |
| E.N.74 | 136/82 watch | 27.9 on track | 7.6 watch | 104 watch | 39 down 22% action |
| C.R.63 | 122/78 on track | 30.4 watch | 6.7 on track | 97 on track | No data |
| Panel | 4 of 8 on track, 2 watch, 1 action, 1 no data | 4 of 8 on track, 3 watch, 1 action | 3 of 6 on track, 2 watch, 1 action | 3 of 7 on track, 1 watch, 2 action, 1 no data | 5 of 8 on track, 1 watch, 1 action, 1 no data |
Want this view for your own ACCESS patients?Write to us about your practice and panel. No commitment.
Talk to us01 The problem
The measures are all in the chart. Just not in one place.
Being in ACCESS means keeping track of where each patient stands on the program's measures. In practice, those numbers are scattered, and some of them never reach your chart at all. Pulling them into one view for every patient in the program becomes a spreadsheet job that nobody on the team has time for.
- Blood pressureIn the vitals from the last visit
- Weight and BMIWherever someone last used a scale
- HbA1c and LDLBack from the lab, sometimes an outside one
- Kidney functionIn a nephrologist's note you may never have received
02 How it works
From a note to us to your panel in view
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01
Talk to us
Tell us about your practice and your ACCESS patients. Triangle's team sets Fivefold up for each practice, so we'll talk it through with you.
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02
Outside records come in
Each patient verifies their identity and signs consent, then Triangle requests their records through the national networks, Carequality and TEFCA. For a new patient, your team gets their outside records and a readable summary before the visit.
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03
Each patient is scored
Dashboards built around the program's kidney and cardiometabolic measures score each patient against the program's targets as on track, watch or action, and show where a result is missing.
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04
The panel, at a glance
Population views count each status across your patients, and you can narrow the list to the patients behind a count, such as everyone marked for action.
03 What you get
Know who needs attention, and on which measure
A per-patient scorecard
Blood pressure, weight and BMI, HbA1c, LDL and kidney function for each patient, scored against the program's targets. HbA1c and LDL are scored only for patients they apply to.
Population views
Status counts across your patients, so the team knows where the practice stands and who needs attention first. Narrow the list to the patients behind any count.
Outside results, not just your own
Labs and notes from other providers arrive through the national networks, and a new patient's outside records come with a readable summary before they arrive.
Quarterly labs, tracked
See whether each patient's quarterly lab panel is current, due or overdue, alongside the results themselves.
Patients' devices, shared with you
Patients can connect devices such as Withings, Dexcom or FreeStyle Libre to their own Triangle account, and share their profile with your team.
Patients' own accounts
Patients' own Triangle accounts start with a 7-day free trial, then $9 a month. Triangle requests their records from hospitals and clinics and keeps them updated, and they can read and ask about their own numbers.
04 Patients' own assistants
Patients can ask Claude or ChatGPT about their own numbers
A patient who uses an AI assistant can connect it to their own Triangle profile. With their permission it can read their records, labs and measurements, medications and wearable readings, so it can answer questions about their own blood pressure, weight, labs and kidney function.
Step-by-step guides for ChatGPT, Claude, Grok, Muse and others
Your clinicians can connect theirs too. A clinician on a patient's team in Triangle can connect their own assistant to that patient's profile, and so can a family member who helps manage it. Each person chooses what their assistant can see.
https://app.trianglehealth.com/mcp
Also shown in Triangle under Settings → AI service connections → Connect.
- Open the assistant's settings and find Connectors, MCP or Tools.
- Add a custom connector with the address above.
- Sign in to Triangle when asked.
- Choose what it can read or change, category by category, and which profile to share. Then accept.
| Assistant | Menu path | Plan and notes |
|---|---|---|
| Claude | SettingsConnectorsAdd custom connectorPaste the address. | A Triangle sign-in appears the first time a Triangle tool is used. |
| ChatGPT | Plugins+Add custom MCP serverEnter a name and the address under Connection, choose OAuth, then Create as a plugin. Sign in to Triangle and accept. In a chat, type @ and pick Triangle. | Business, Enterprise or Edu, added by a workspace admin. Pro connects read-only. |
| Grok | Skills and ConnectorsNew ConnectorCustomEnter a name and the address, then sign in to Triangle and accept. | Paid plan. |
What a patient might ask it
- BP"What were my last five blood pressure readings, and when were they taken?"
- eGFR"How has my kidney function changed since last year?"
- Weight"Remind me every Sunday at 9 to log my weight."
Privacy and control
- Each category has its own Read and Write switch, and whoever connects it picks which profile to share.
- What the assistant reads is then handled under that assistant's own privacy policy, which Triangle does not control. Connect only assistants you trust.
- It works only with data inside Triangle and can't change anything at a hospital or clinic.
- Each person can disconnect their own connections any time in Triangle under Settings → AI service connections, and access stops immediately.
Questions about how your patients would use it?Write to us and Triangle's team will reply.
Talk to us05 Trust
Clinical data, handled carefully
Protected
Everything is encrypted. Triangle describes itself as HIPAA compliant; the details are in its Trust Center.
Never sold
Patient data is never sold or shared for advertising. Patients decide what to share and with whom, and their records are theirs to delete.
Independent
No drug maker, laboratory or hospital pays Triangle. Triangle is listed in the Medicare App Library.
Triangle provides research and educational support. It does not diagnose, treat, or prescribe, and it never replaces your care team.
06 Questions
What practices ask first
What does it cost?
We'll talk through pricing for your practice when you write. Patients' own Triangle accounts work like this: a 7-day free trial (a card is required, and if they cancel before day 7 they're not charged), then $9 a month, cancel any month. Membership covers Triangle requesting their records from hospitals and clinics and keeping them updated, a chat that answers from their own records, a review of their medical history by a licensed clinician, connecting their devices, and uploading anything else they have.
What does setting up take?
Start by writing to us. Triangle's team sets Fivefold up for each practice, so we'll talk through your panel and how your patients join. Each patient verifies their identity and signs consent before Triangle requests their outside records.
Which measures does it cover?
Blood pressure, weight and BMI, HbA1c, LDL and kidney function, built around the program's kidney and cardiometabolic measures. HbA1c and LDL are scored only for patients they apply to. If you need something beyond those, tell us when you write.
Where does the data come from?
From patients' records in Triangle, including outside records requested through the national networks, Carequality and TEFCA, and documents added to Triangle. Not every provider is reachable through the networks, which is why a result can show as missing; documents can be added for anything that doesn't come through.
Does Fivefold diagnose, treat or prescribe?
No. Fivefold organizes records and scores measures. Clinical decisions stay with your clinicians. Triangle does not diagnose, treat or prescribe.
Who is behind Fivefold, and how is patient data handled?
Fivefold is made by Triangle. Your message goes to Triangle's team, and any accounts are created with Triangle under its privacy policy and terms. Triangle describes itself as HIPAA compliant, with details in its Trust Center. Everything is encrypted, and patient data is never sold or shared for advertising.
07 Next step
Talk to us about your ACCESS panel
Tell us a little about your practice, how many patients are in the program and the measures you're tracking. Your note goes to support@trianglehealth.com, and Triangle's team will reply.
No commitment. Fivefold is made by Triangle.