Neil Batlivala spent seven years building a healthcare company that serves a patient population that most of the tech industry has never heard of and most of Silicon Valley ignores. But last month, it put him at the center of something much bigger.
His company, Pair Team, announced April 30 that it had been accepted into ACCESS, the Medicare program. This is one of 150 participants selected by the Centers for Medicare and Medicaid Services to test what AI-based health care could look like at the federal level. This program starts on July 5th.
“The government is creating a swimming path for AI innovation in traditionally regulated industries,” he said on a Zoom call a few days later. “The best solution wins. That’s not true in a regulated industry like healthcare.”
ACCESS (Advancing Chronic Care with Effective and Scalable Solutions) is a 10-year CMS program testing payment models that reward health outcomes rather than essential activities (e.g., a certain number of check-ins). Participating organizations, like Pair Team, receive predictable payments for the management of qualifying conditions and earn the full amount only when patients achieve measurable health goals, such as lowering blood pressure or reducing pain. This addresses diabetes, high blood pressure, chronic kidney disease, obesity, depression and anxiety.
That payment structure is the real news.
Traditional Medicare compensates based on time spent with a clinician. There is no mechanism to pay for an AI agent to monitor patients between visits, make check-in calls, coordinate accommodation recommendations, or have someone pick up their medications. ACCESS is the first to create such a mechanism.
“This is a change in the payment model,” Batlivala said. “This has never been possible before.”
The first cohort consists of a wide range of participants, including AI physician startups, virtual nutritional therapy providers, connected device companies, and wearable manufacturers such as Whoop. Batlivala is skeptical of some of them.
“I’m a big fan of wearables, but I don’t know how much Whoop can do for seniors struggling with food insecurity,” he added of his company. “We’ve been working on this for more than five years.”
Pair Team launched in 2019 with a specific type of patient in mind. People managing chronic conditions face unstable housing, too little food, or lack of transportation. About a third of Americans fall into this category.
The company’s premise was that you can’t improve health outcomes without addressing the full context of someone’s life. Today, the company employs approximately 850 clinical professionals, operates California’s largest community health workforce, and generates more than nine figures in revenue, according to Batlivala. It has raised about $30 million, with backing from Kleiner Perkins, Kraft Ventures and Next Ventures.
This model has peer-reviewed evidence. A study co-authored by Fair Team researchers and peer-reviewed by the Journal of General Internal Medicine evaluated pair Team’s community integration model, which blends medical, behavioral, and social care for Medicaid members with high rates of homelessness and serious mental illness and chronic conditions, and found strong patient engagement and significant reductions in avoidable emergencies and inpatient utilization. Batlivala says one in four hospital visits and one in two emergency room visits do not occur while patients are receiving care from the company.
But for many years, providing that level of care required human teams, limiting the speed and cost of expansion. Then, about nine months ago, the Fair team deployed a voice AI agent called Flora as the primary patient-facing interface. Flora is available 24 hours a day and processes intake, coordinates referrals, and performs check-ins to keep patients engaged between clinical visits.
The first call that changed his thinking was with a 67-year-old woman who lives out of her car and manages PTSD and congestive heart failure. She talked to Flora for over an hour. “It was incredibly depressing and depressing,” Batlivala said. “Flora was probably the only ‘person’ she talked to about her situation for weeks.” Now, an hour-long conversation with Flora has become routine. “It’s a companion piece,” he said. “And it turned out to be a real intervention.”
The designer of ACCESS was a former startup operator. The program was designed by Abe Sutton, director of the CMS Innovation Center, and Jacob Shiff, chief AI and technology officer at the CMS Innovation Center. Sutton was previously a venture capitalist at a healthcare fund called Rubicon Founders. Shiff is a former healthcare entrepreneur. Both joined CMS under the Trump administration, and their startup backgrounds are reflected in the design of programs that include outcomes-based payments, direct-to-consumer enrollment, and an intentional push for competition.
There is a real risk. Participants are providing highly sensitive patient data—housing, intimate conversations about illness and mental illness—to federal infrastructure with a documented history of breaches, including exposed Social Security numbers. This is not an impractical issue, as ACCESS is designed to provide services for vulnerable populations.
There are also financial risks. The performance of CMS innovation programs is mixed. Instead of achieving projected savings, the CMS Innovation Center increased federal spending by $5.4 billion over the first 10 years, according to a 2023 Congressional Budget Office analysis. CMS is also paying less per patient per month than many participants expected. This means that math only works in organizations that have fully automated most patient interactions.
Batlivala’s answer to the refund issue is that it’s a feature, not a bug. “To build a model that truly incentivizes the use of AI, reimbursement rates need to be low,” he said. “The economics only pay off if you run AI-first operations efficiently.”
Pair Team says it currently has partnerships to reach about 500,000 potential patients and hopes to reach 1 million within three years.
Healthcare investors have been watching this closely. Digital health funds recorded their highest first-quarter totals since the pandemic this year, with AI companies accounting for the majority. However, ACCESS has little registration outside of the medtech industry press.
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