Neil Batlivala has spent seven years building a healthcare company that most of the tech industry has never heard of and that serves a patient population that most of Silicon Valley ignores. But last month, that job put him at the center of something much bigger.
Your company, couple teamannounced on April 30 that it had been accepted in ACCESSa Medicare program, as one of 150 participants chosen by the Centers for Medicare & Medicaid Services to test what AI-powered healthcare could look like on a federal scale. The program will be available on July 5.
“The government is creating lanes for AI innovation in traditionally regulated industries,” he told me on a Zoom call a few days later. “The best solution wins, which, in regulated industries like healthcare, that hasn’t been the case.”
ACCESS (Advancing Chronic Care with Effective and Scalable Solutions) is a 10-year CMS program testing a payment model that rewards health outcomes rather than required activities (such as a certain number of checkups). Participating organizations like Pair Team receive predictable payments for managing qualifying conditions and earn the full amount only when patients achieve measurable health goals, such as lower blood pressure or reduced pain. Covers diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety.
That payment structure is the real news.
Traditional Medicare reimbursements are based on time spent with a doctor. There is no mechanism to pay an AI agent who monitors a patient between visits, calls to check in, arranges an accommodation referral, or makes sure someone picks up their medications. ACCESS creates such a mechanism for the first time.
“It’s a transformation of the payment model,” Batlivala said. “You just couldn’t do this before.”
The first cohort spans a wide range of participants: AI doctor startups, virtual nutritional therapy providers, connected device companies, and wearable device makers like Whoop. Batlivala is skeptical of some of them.
“I’m a big fan of wearables, but for a senior who is struggling with food insecurity, I don’t know how much Whoop will be able to do,” he said, adding of his own company: “We’ve been building this for over five years.”
Pair Team launched in 2019 with a specific type of patient in mind: people who suffer from chronic illnesses and also face unstable housing, very little food, or lack of transportation. About a third of Americans fall somewhere in that category.
The company’s premise was that you cannot improve health outcomes without addressing the full context of a person’s life. It now employs approximately 850 clinical professionals, runs what it describes as the largest community health workforce in California, and, according to Batlivala, generates revenues in excess of nine figures. It has raised about $30 million, backed by Kleiner Perkins, Kraft Ventures and Next Ventures.
The model has peer-reviewed evidence behind it. A study, co-authored by Pair Team researchers and peer-reviewed by the Journal of General Internal Medicineevaluated Pair Team’s community-integrated model, which combines medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic illness, and showed strong patient engagement and significant reductions in preventable emergency and inpatient utilization. Batlivala says one in four hospital visits and one in two emergency room visits do not occur when a patient is under his company’s care.
But for years, providing that level of care required human teams, which limited speed and low-cost scale. Then, about nine months ago, Pair Team implemented a voice AI agent called Flora as its primary patient-facing interface. Flora is available 24 hours a day, handling intake, coordinating referrals, and performing check-ins that keep patients engaged between clinic visits.
The first call that changed his thinking was from a 67-year-old woman living in her car who was suffering from post-traumatic stress disorder and congestive heart failure. He talked to Flora for over an hour. “It was amazing and depressing at the same time,” Batlivala told me. “Flora was probably the only ‘person’ he had spoken to in weeks about his situation.” Now, hour-long conversations with Flora are routine. “That’s the camaraderie piece,” he said. “And it turns out it’s really an intervention.”
The architects of ACCESS are themselves former startup operators. The program was designed by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Director of Technology and Artificial Intelligence at the CMS Innovation Center. Sutton was previously a venture capitalist at a healthcare fund called Rubicon Founders. Shiff is a former healthcare founder. Both joined CMS under the Trump administration, and their startup backgrounds are reflected in the program’s design: outcomes-based payments, direct-to-consumer enrollment, and a deliberate push for competition.
There are real risks. Participants are feeding extraordinarily sensitive patient data—intimate conversations about housing, illness, 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 not an impractical concern.
There are also financial risks. The track record of CMS innovation programs is mixed. A congressional budget office for 2023 analysis found that the CMS Innovation Center increased federal spending by $5.4 billion during its first decade rather than producing the projected savings. CMS also pays less per patient per month than many participants anticipated, meaning the math only works for organizations that have fully automated most of their interactions with patients.
Batlivala’s response to the refund concern is that it’s a feature, not a bug. “If you want to build a model that truly incentivizes the use of AI, reimbursement rates have to be low,” he told me. “The economy only works if you run an efficient operation that prioritizes AI.”
Pair Team says it currently has partnerships that give it access to approximately 500,000 potential patients and wants to reach one million within three years.
Investors in the healthcare sector have been following this closely. Digital health funding peaked highest first quarter total since the pandemic this year, and AI companies have taken over most of it. But ACCESS has barely registered outside the health technology press.
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