For seven years, Neil Batlivala has been dedicated to building a healthcare company that remains largely unknown in the tech industry and addresses the needs of a patient demographic often overlooked in Silicon Valley. Recently, his efforts have brought him into the spotlight of a significant development.
His company, Pair Team, announced on April 30 that it had been accepted into ACCESS, a Medicare program. This initiative, selected by the Centers for Medicare & Medicaid Services, includes 150 participants aiming to explore the potential of AI-driven healthcare on a federal level. The program is set to commence on July 5.
“The government is providing opportunities for AI innovation in traditionally regulated industries,” Batlivala shared over a Zoom call recently. “The most effective solution prevails, which hasn’t always been the case in regulated fields like healthcare.”
ACCESS, or Advancing Chronic Care with Effective, Scalable Solutions, is a decade-long CMS program aimed at testing a payment model that incentivizes health outcomes rather than predefined activities like frequent check-ins. Organizations like Pair Team will receive consistent payments for managing specific conditions and will earn full payment only when patients achieve tangible health improvements, such as reduced blood pressure or pain. The program covers conditions like diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety.
The novelty of this payment structure is noteworthy.
Traditional Medicare compensates based on the time a clinician spends with a patient. However, it lacks a system to reimburse AI agents that monitor patients between visits, make check-in calls, arrange housing referrals, or ensure medication pickup. ACCESS introduces this mechanism for the first time.
“This represents a transformation in payment models,” Batlivala said. “Previously, this wasn’t possible.”
The initial group of participants includes a diverse range of entities—AI doctor startups, virtual nutrition therapy providers, connected device companies, and wearable manufacturers like Whoop. Batlivala expresses skepticism towards some of them.
“I appreciate wearables, but for seniors facing food insecurity, I question the impact Whoop can have,” he remarked, referring to his company, “We’ve been working towards this for more than five years.”
Pair Team began in 2019, focusing on patients managing chronic conditions while also dealing with unstable housing, insufficient food, or transportation issues. Approximately a third of Americans fit this profile.
The company operates on the principle that health outcomes cannot improve without considering a person’s entire life context. Currently, it employs around 850 clinical professionals and claims the largest community health workforce in California. Batlivala states that the company generates over nine figures in revenue and has raised about $30 million from investors like Kleiner Perkins, Kraft Ventures, and Next Ventures.
Their model is backed by peer-reviewed research. A study co-authored by Pair Team researchers and published in the Journal of General Internal Medicine evaluates their community-integrated model. This approach combines medical, behavioral, and social care for Medicaid members with high rates of homelessness, mental illness, and chronic disease, demonstrating strong patient engagement and significant reductions in avoidable emergency and inpatient care. Batlivala notes that one in four hospital visits and half of ER visits are prevented under his company’s care.
Historically, delivering such comprehensive care required human teams, limiting scalability and cost-efficiency. Nine months ago, Pair Team launched a voice AI agent named Flora as its main patient interface. Available 24/7, Flora manages intake, coordinates referrals, and conducts check-ins to maintain patient engagement between clinical visits.
A pivotal moment was a call with a 67-year-old woman living in her car, dealing with PTSD and congestive heart failure. She conversed with Flora for over an hour. “It was both remarkable and sad,” Batlivala reflected. “Flora was likely the only ‘person’ she had spoken to about her situation in weeks.” These hour-long conversations with Flora are now common. “That companionship aspect is crucial,” he said. “And it turns out to be a significant intervention.”
The creators of ACCESS come from startup origins themselves. Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief AI and Technology Officer, designed the program. Sutton was previously a venture capitalist at Rubicon Founders, a healthcare fund, while Shiff was a healthcare founder. Both joined CMS under the Trump administration, and their startup experiences are evident in the program’s structure: outcome-based payments, direct-to-consumer enrollment, and a focus on competition.
There are significant risks involved. Participants are providing highly sensitive patient data—personal discussions about housing, health, and mental illness—to a federal system with a history of breaches, including exposed Social Security numbers. For the vulnerable groups ACCESS aims to support, this is a valid concern.
Financial risks also exist. CMS innovation programs have shown mixed results. A 2023 Congressional Budget Office report revealed that the CMS Innovation Center increased federal spending by $5.4 billion over its first decade instead of delivering expected savings. Additionally, CMS pays less per patient each month than many participants anticipated, meaning the financial model only works for organizations that have largely automated patient interactions.
Batlivala sees the reimbursement issue as a positive aspect. “If the goal is to encourage AI use, then low reimbursement rates are necessary,” he explained. “The economics are viable only with a streamlined, AI-focused operation.”
Pair Team indicates it currently has partnerships that provide access to around 500,000 potential patients and aims to expand that number to a million within three years.
Healthcare investors are closely observing these developments. Digital health funding reached its highest first-quarter total since the pandemic this year, with AI companies securing the majority. However, ACCESS has gained little attention outside health tech trade media.
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