For years, Neil Batlivala and his company, Pair Team, have quietly built a healthcare solution addressing a patient population often overlooked by the tech world. Their dedication recently placed them at the forefront of a major shift in federal healthcare policy.
On April 30th, Pair Team announced its selection into ACCESS, a groundbreaking Medicare program. This initiative, kicking off on July 5th, aims to explore the potential of AI-driven medical care at a national scale, with Pair Team being one of just 150 chosen participants.
Batlivala sees this as a pivotal moment, noting that “The government is creating swim lanes for AI innovation in traditionally regulated industries.” He emphasizes that in this new landscape, “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”
Medicare’s New Blueprint: Outcome-Based Healthcare
ACCESS, which stands for Advancing Chronic Care with Effective, Scalable Solutions, is a visionary 10-year program spearheaded by the Centers for Medicare & Medicaid Services (CMS). Its core innovation lies in a new payment model that rewards tangible health outcomes rather than simply the completion of medical activities.
Under ACCESS, participating organizations like Pair Team receive predictable payments for managing specific chronic conditions. These include widespread issues such as diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety.
Crucially, they earn the full payment only when patients achieve measurable health goals, like lower blood pressure or reduced pain. This fundamentally shifts the focus from volume of services to the quality and effectiveness of care.
This marks a significant departure from traditional Medicare, which typically reimburses based on time spent with a clinician. Previously, there was no established mechanism to pay for innovative interventions such as an AI agent monitoring patients between visits, making proactive calls, coordinating social support like housing referrals, or ensuring medication adherence.
ACCESS now creates that vital mechanism, enabling payment for these crucial, non-traditional care activities for the very first time. As Batlivala aptly puts it, this represents a “payment model transformation” that simply wasn’t possible before.
Pair Team’s AI-Driven Approach to Vulnerable Populations
Launched in 2019, Pair Team was founded on a profound understanding: you cannot truly improve health outcomes without addressing the complete context of a patient’s life. They specifically target individuals managing chronic conditions who also face social determinants of health, such as unstable housing, food insecurity, or lack of transportation – a demographic representing about a third of all Americans.
The company now employs roughly 850 clinical professionals and operates what it describes as the largest community health workforce in California. Their integrated model, blending medical, behavioral, and social care, has shown remarkable results.
A study co-authored by Pair Team researchers and peer-reviewed by the Journal of General Internal Medicine evaluated their community-integrated model for Medicaid members. It showed strong patient engagement and significant reductions in avoidable emergency and inpatient utilization, with Batlivala reporting that one in four hospital visits and one in two ER visits are avoided when patients are in their care.
For years, delivering this high level of holistic care required extensive human teams, which inherently limited scalability. However, about nine months ago, Pair Team introduced ‘Flora,’ a sophisticated voice AI agent, as its primary patient-facing interface.
Flora now operates 24/7, handling patient intake, coordinating referrals, and conducting crucial check-ins that keep patients engaged between clinical appointments. This AI-driven solution has transformed their capacity to provide continuous, compassionate care, even for the most complex cases.
Batlivala recounts a poignant early interaction where a 67-year-old woman, living in her car and managing PTSD and congestive heart failure, spoke with Flora for over an hour. This demonstrated not just Flora’s utility but also its role in providing vital companionship, proving that such interactions can be a powerful intervention in themselves.
Navigating the Challenges and Future of AI in Healthcare
The architects behind ACCESS, Abe Sutton and Jacob Shiff of the CMS Innovation Center, are themselves former startup operators, bringing a unique perspective to federal policy. Their backgrounds as a venture capitalist and a healthcare founder are evident in the program’s design, emphasizing outcome-based payments, direct-to-consumer enrollment, and competitive innovation.
However, this ambitious program is not without its challenges. Participants will be processing extremely sensitive patient data—intimate conversations about housing, diseases, and mental illness—within a federal infrastructure that has a documented history of security breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS is designed to serve, this is a significant and practical concern.
There are also substantial financial considerations. Previous CMS innovation programs have had a mixed track record, with a 2023 Congressional Budget Office analysis finding increased federal spending by $5.4 billion during its first decade rather than producing projected savings. Furthermore, the per-patient-per-month reimbursement rates for ACCESS are lower than many participants anticipated.
For Pair Team, however, these lower rates are a deliberate design feature, not a flaw. Batlivala believes that to truly incentivize the use of AI, reimbursement rates must be low, forcing organizations to build lean, AI-first operations where the economics only work with high efficiency.
With partnerships providing access to approximately 500,000 potential patients and an ambitious goal to reach one million within three years, Pair Team is poised for significant growth. While digital health funding, particularly for AI, is booming, the ACCESS program itself remains largely under the radar outside of specialized health tech circles.
This quiet revolution, spearheaded by programs like ACCESS and innovators like Pair Team, represents a critical juncture for the future of healthcare. It’s a bold experiment in leveraging technology to deliver better, more equitable outcomes for our most vulnerable populations.
Source: TechCrunch – AI
