CMS Just Launched a New Model to Transform Chronic Care. Here Is What It Means for Black and Underserved Communities — and How DaisyMe Foundation Is Already Doing This Work.

On July 5, 2026, the Centers for Medicare & Medicaid Services (CMS) launched the ACCESS Model — short for Advancing Chronic Care with Effective, Scalable Solutions. It is one of the most significant shifts in how Medicare pays for chronic disease management in years, and it has direct implications for the communities DaisyMe Foundation was built to serve.

Here is what the model does, why it matters for Black and low-income Medicare patients, where the equity gaps remain — and what DaisyMe Foundation is doing right now to make sure our community does not get left behind.

The ACCESS Model is a voluntary, 10-year payment innovation test run by the CMS Innovation Center. It is designed to solve a specific problem: Original Medicare has historically had no good way to pay for technology-supported chronic care — things like telehealth coaching, wearable health monitoring, digital behavior change programs, and remote care coordination.

Under traditional fee-for-service Medicare, payment is tied to specific activities: a visit, a procedure, a test. That model does not fit the way modern chronic disease management actually works — which is continuous, relationship-based, and increasingly technology-enabled.

ACCESS changes that by introducing Outcome-Aligned Payments (OAPs): recurring payments to participating care organizations that are tied not to what they do, but to whether patients actually improve.

The model focuses on four clinical tracks:

1. Early cardio-kidney-metabolic (eCKM): High blood pressure, high cholesterol, obesity/overweight with central obesity, and prediabetes
2. Cardio-kidney-metabolic (CKM): Diabetes, chronic kidney disease (stages 3a/3b), and atherosclerotic cardiovascular disease
3. Musculoskeletal (MSK): Chronic musculoskeletal pain
4. Behavioral health (BH): Depression and anxiety

These four tracks cover conditions that affect more than two-thirds of all people with Medicare — and they disproportionately affect Black Americans.

The conditions ACCESS targets are not evenly distributed across the population. Black Americans:

• Are 30% more likely to die from heart disease than white Americans
• Develop hypertension earlier and at higher rates — and are less likely to have it controlled
• Are diagnosed with Type 2 diabetes at nearly twice the rate of white Americans
• Are more likely to have multiple chronic conditions simultaneously (known as multimorbidity)
• Are significantly more likely to be undertreated for pain, including chronic musculoskeletal conditions
• Experience higher rates of depression and anxiety, with far less access to mental health care

In other words, the four conditions ACCESS targets are precisely the conditions that have been systematically undertreated in Black communities for decades.

The model's explicit goal — paying for outcomes rather than activities — is a direct challenge to a system that has long rewarded volume over results. If it works as designed, it could mean that Medicare patients with hypertension in Frisco, TX get the same quality of technology-supported care as patients in affluent suburbs with better-resourced health systems.

That is a meaningful promise. But promises require follow-through.

The ACCESS Model is a genuine step forward. But it does not automatically solve the structural barriers that have kept Black and low-income communities from accessing quality chronic care. Here is what to watch:

Who participates matters enormously. ACCESS is voluntary. Organizations apply to participate, and CMS reviews applications on a rolling basis (the next start dates are August 17 and October 1, 2026). If the organizations that apply are concentrated in affluent, well-resourced areas — and if they do not actively recruit patients from underserved communities — the model will replicate existing disparities at scale.

Technology access is not universal. The model relies heavily on telehealth, wearable devices, and digital health apps. For patients without reliable broadband, smartphones, or digital literacy, "technology-supported care" can quickly become "care that was never actually available to me." The model includes a rural adjustment, but urban underserved communities — like many parts of Frisco and the broader DFW area — face similar access barriers without the same protections.

Trust is not assumed. Black Americans have well-founded reasons to approach new healthcare programs with caution. A model that asks patients to share health data through apps and wearable devices, managed by organizations they may never have heard of, will face real trust barriers. Organizations that have not done the work of building community trust will struggle to enroll the patients who need this care most.

Referral pathways require informed primary care. ACCESS is designed to work alongside primary care — PCPs can refer patients and receive updates on their progress. But if a patient's primary care provider does not know about ACCESS, does not understand it, or does not have relationships with participating organizations in their area, the referral pathway breaks down before it starts.

Outcomes must be disaggregated. CMS has committed to publishing risk-adjusted outcomes publicly. But "risk-adjusted" does not automatically mean "equitable." Advocates and community organizations need to watch whether outcomes data is broken down by race, income, and geography — and push back loudly if it is not.

DaisyMe Foundation does not wait for federal models to catch up to community need. We have been doing the work that ACCESS is trying to incentivize — and we have been doing it for free, in Frisco, TX, with no insurance required.

Here is how our programs align with what ACCESS is trying to accomplish:

The ACCESS Model assumes patients can find participating organizations, understand their options, enroll voluntarily, and stay engaged over time. For many Medicare patients — especially older adults, those with limited English proficiency, and those who have been burned by the healthcare system before — that assumption is wrong.

Our Care Navigation program provides exactly the human infrastructure that makes technology-supported care work in practice. Our navigators:

• Help community members understand what programs like ACCESS exist and whether they qualify
• Connect patients with participating providers and help them ask the right questions before enrolling
• Follow up to make sure patients are actually receiving the care they signed up for
• Advocate when something goes wrong — when a device does not work, a telehealth appointment gets dropped, or a care update never reaches the primary care provider

No app does this. No wearable does this. People do this — and DaisyMe Foundation has people doing it right now.

Technology-supported chronic care only works if patients understand what their numbers mean, why their goals matter, and how to use the tools they are given. A blood pressure cuff that a patient does not know how to read, or a hemoglobin A1c target that was never explained, is not care — it is equipment.

Our Community Health Education workshops — including our Patient Self-Advocacy & Provider Bias track — build the health literacy that makes programs like ACCESS effective. We teach community members:

• What hypertension, diabetes, and chronic kidney disease actually mean for their bodies
• How to interpret their own lab results and vital signs
• How to have productive conversations with their care team about their goals
• How to recognize when a technology-supported program is working — and when to push back

When a Medicare patient in our community enrolls in an ACCESS-participating organization, we want them to walk in knowing exactly what outcomes they are working toward and why.

DaisyMe Foundation is committed to monitoring how the ACCESS Model performs for Black and underserved communities. We will be watching:

• Whether participating organizations are present in communities like ours
• Whether outcomes data is disaggregated by race and income
• Whether the rural adjustment is extended to urban underserved areas
• Whether the model's trust and technology-access barriers are being addressed

When we see gaps, we will name them — in our newsroom, in our community workshops, and in our advocacy work.

If you have Original Medicare and you manage hypertension, diabetes, chronic kidney disease, chronic pain, depression, or anxiety, the ACCESS Model may eventually give you access to new care options — technology-supported programs that can help you manage your conditions between doctor's visits, with regular check-ins and measurable goals.

Here is what to do right now:

1. Talk to your primary care provider. Ask whether they are aware of the ACCESS Model and whether there are participating organizations in your area. The next enrollment start dates are August 17 and October 1, 2026.

2. Ask questions before you enroll in any program. If a care organization approaches you about ACCESS, ask: What conditions do you treat? What are my outcome targets? How will you share updates with my primary care doctor? What happens to my health data?

3. Contact DaisyMe Foundation. Whether or not ACCESS is available in your area, our Care Navigation team can help you understand your options, prepare for appointments, and advocate for the care you deserve. All of our services are 100% free.

The CMS ACCESS Model is a serious attempt to fix a real problem: Medicare's inability to pay for the kind of continuous, technology-supported chronic care that actually works. For Black and low-income communities that carry the heaviest burden of the conditions ACCESS targets, this model has genuine potential.

But potential is not the same as impact. Impact requires organizations that show up in underserved communities, patients who are informed and empowered enough to participate, and advocates who hold the system accountable when the data reveals disparities.

DaisyMe Foundation is doing all three — right now, in Frisco, TX, and growing nationally.

If you want to understand what ACCESS means for you or someone you love, or if you want to get involved in making sure this model works for our community, reach out to us today.

Source: CMS Innovation Center. "ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model." CMS.gov, last modified July 20, 2026. cms.gov/priorities/innovation/innovation-models/access

DaisyMe Foundation does not provide medical advice. This article is for educational and advocacy purposes only. Please consult a qualified healthcare provider before making any decisions about your care.