For seven years, Neil Batlivala built a healthcare company serving a population most of Silicon Valley overlooks: people managing chronic illness alongside unstable housing, food insecurity, or lack of transportation. That company, Pair Team, now finds itself at the center of a federal experiment that could reshape how Medicare pays for AI-driven medical care.
What is ACCESS?
On April 30, Pair Team was announced as one of 150 participants in ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — a 10-year program from the Centers for Medicare & Medicaid Services (CMS) that launches July 5. Unlike traditional Medicare, which reimburses based on clinician time, ACCESS pays organizations a predictable monthly fee for managing conditions like diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. The full payment is earned only when patients hit measurable health goals — lower blood pressure, reduced pain, sustained engagement.
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“The government is creating swim lanes for AI innovation in traditionally regulated industries,” Batlivala told TechCrunch. “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”
Why this matters for AI in healthcare
The payment structure is the real story. Traditional Medicare has no mechanism to pay for an AI agent that monitors a patient between visits, coordinates a housing referral, or ensures medication adherence. ACCESS creates that mechanism for the first time. “It’s a payment model transformation,” Batlivala said. “You just couldn’t do this before.”
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The first cohort includes a wide range of participants: AI doctor startups, virtual nutrition therapy providers, connected device companies, and wearable makers like Whoop. Batlivala is skeptical of some. “I’m a big fan of wearables, but for a senior who’s struggling with food insecurity, I don’t know how much Whoop is going to be able to do,” he said.
Pair Team’s approach: AI meets social care
Pair Team launched in 2019 with a focus on patients managing chronic conditions while also dealing with unstable housing, food insecurity, or lack of transportation — about a third of Americans. The company now employs roughly 850 clinical professionals, runs what it describes as the largest community health workforce in California, and generates revenue above nine figures, backed by Kleiner Perkins, Kraft Ventures, and Next Ventures.
About nine months ago, Pair Team deployed a voice AI agent called Flora as its primary patient-facing interface. Flora handles intake, coordinates referrals, and performs check-ins between clinical visits. Batlivala recalls a important call with a 67-year-old woman living out of her car, managing PTSD and congestive heart failure. She spoke with Flora for over an hour. “Flora was probably the only ‘person’ she’d talked to in weeks about her situation,” he said. Now, hour-long conversations with Flora are routine. “That’s the companionship piece. And it turns out that is truly an intervention.”
The architects behind the model
ACCESS was designed by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief AI and Technology Officer. Both joined CMS under the Trump administration and have startup backgrounds — Sutton was a venture capitalist at Rubicon Founders; Shiff is a former healthcare founder. Their experience is reflected in the program’s design: outcome-based payments, direct-to-consumer enrollment, and a deliberate push for competition.
Risks and realities
The program feeds sensitive patient data — intimate conversations about housing, disease, and mental illness — into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS is designed to serve, that is a practical concern.
There are financial risks too. A 2023 Congressional Budget Office analysis found that the CMS Innovation Center increased federal spending by $5.4 billion during its first decade rather than producing projected savings. CMS is also paying less per patient per month than many participants anticipated, meaning the math only works for organizations that have fully automated most patient interactions.
Batlivala sees the low reimbursement as a feature. “If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low,” he said. “The economics only work if you’re running a lean, AI-first operation.”
What’s next
Pair Team says it has partnerships giving it access to roughly 500,000 potential patients and aims to reach one million within three years. Digital health funding hit its highest Q1 total since the pandemic this year, with AI companies capturing the bulk. But ACCESS has barely registered outside health tech trade press. That may change as the program goes live and its implications become clearer.
Conclusion
ACCESS represents a rare moment where federal payment policy is explicitly designed to enable AI-driven care. Whether it delivers on its promise — or repeats the pattern of past CMS innovation programs that increased costs — will depend on execution, privacy safeguards, and whether the economics truly work for the patients who need it most.
FAQs
Q1: What is the ACCESS Medicare program?
A: ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year CMS pilot that pays organizations a flat monthly fee for managing chronic conditions, with full payment tied to measurable health outcomes rather than the number of clinician visits.
Q2: How does ACCESS differ from traditional Medicare payment?
A: Traditional Medicare reimburses based on time spent with a clinician. ACCESS creates a payment mechanism for AI-driven interventions, remote monitoring, and social care coordination — services that previously had no billing code.
Q3: What are the risks of the program?
A: Key risks include data privacy breaches given the sensitivity of patient information, potential cost overruns (past CMS innovation programs increased federal spending), and the challenge of making the economics work with lower-than-expected per-patient payments.
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