For seven years, Neil Batlivala has dedicated himself to cultivating a healthcare enterprise largely unknown to the broader tech sector, one that caters to a patient demographic frequently overlooked by Silicon Valley. However, his persistent efforts recently propelled him into a pivotal role within a much larger initiative.
On April 30, his company, Pair Team, revealed its selection as one of 150 participants in ACCESS, a pioneering Medicare program. Chosen by the Centers for Medicare & Medicaid Services (CMS), Pair Team will contribute to exploring the potential of AI-driven medical care nationwide, with the program commencing on July 5.
Reflecting on this development during a subsequent Zoom conversation, Batlivala observed, “The government is creating swim lanes for AI innovation in traditionally regulated industries.” He emphasized the competitive shift, stating, “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”
ACCESS, standing for Advancing Chronic Care with Effective, Scalable Solutions, is a decade-long CMS program designed to pilot a novel payment framework. This model incentivizes health outcomes over prescribed activities, such as a fixed number of check-ins. Organizations like Pair Team receive consistent payments for managing specific chronic conditions, with full remuneration contingent upon patients achieving quantifiable health targets, including reduced blood pressure or alleviated pain. The program addresses conditions such as diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety.
This innovative payment structure represents a significant paradigm shift.
Unlike traditional Medicare, which bases reimbursement on direct clinician-patient contact time, there has historically been no provision to compensate for AI agents monitoring patients between appointments, conducting check-in calls, facilitating housing referrals, or ensuring medication adherence. ACCESS fundamentally changes this by establishing such a mechanism for the first time.
“It’s a payment model transformation,” Batlivala affirmed, underscoring its unprecedented nature: “You just couldn’t do this before.”
The initial cohort of participants is diverse, encompassing AI doctor startups, virtual nutrition therapy providers, connected device firms, and wearable manufacturers such as Whoop. Batlivala, however, expresses reservations about certain participants within this group.
“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 commented, drawing a distinction with Pair Team’s long-standing strategy: “We've been building toward this for five-plus years now.”
Established in 2019, Pair Team was founded with a clear focus on a specific patient demographic: individuals managing chronic conditions while simultaneously contending with challenges like housing instability, food insecurity, or limited transportation. Approximately one-third of the American population experiences some form of these compounding issues.
The company’s fundamental premise posits that optimizing health outcomes necessitates addressing the comprehensive context of an individual’s life. Pair Team currently employs approximately 850 clinical professionals and operates what it identifies as California’s largest community health workforce. According to Batlivala, the company’s revenue exceeds nine figures, having secured around $30 million in funding from investors including Kleiner Perkins, Kraft Ventures, and Next Ventures.
This integrated care model is supported by peer-reviewed research. A study, co-authored by Pair Team researchers and published in the Journal of General Internal Medicine, assessed the company's community-integrated approach. This model combines medical, behavioral, and social care for Medicaid beneficiaries grappling with high rates of homelessness, serious mental illness, and chronic disease. The findings demonstrated robust patient engagement and substantial reductions in preventable emergency and inpatient hospital utilization. Batlivala claims that when patients are under Pair Team’s care, one in four hospital visits and one in two ER visits are avoided.
For years, however, delivering this comprehensive level of care relied heavily on human teams, which inherently constrained its speed and cost-effective scalability. Approximately nine months ago, Pair Team addressed this by deploying Flora, a voice AI agent, as its primary patient-facing interface. Flora operates 24/7, managing intake processes, coordinating referrals, and conducting regular check-ins to maintain patient engagement between clinical appointments.
A pivotal moment that reshaped Batlivala’s perspective involved a 67-year-old woman, living in her car and coping with PTSD and congestive heart failure, who conversed with Flora for over an hour. “It was both incredible and depressing,” Batlivala recounted. “Flora was probably the only ‘person’ she'd talked to in weeks about her situation.” Such extended conversations with Flora have since become commonplace. “That's the companionship piece,” he noted, adding, “And it turns out that is truly an intervention.”
Notably, the architects behind ACCESS possess backgrounds as former startup operators. The program was conceptualized by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief AI and Technology Officer of the CMS Innovation Center. Sutton previously served as a venture capitalist at Rubicon Founders, a healthcare fund, while Shiff is a former healthcare founder. Both joined CMS during the Trump administration, and their entrepreneurial experiences are evident in the program’s design, which features outcome-based payments, direct-to-consumer enrollment, and a strong emphasis on competition.
However, significant risks are inherent in this initiative. Participants will be inputting exceptionally sensitive patient data—including intimate details concerning housing, illnesses, and mental health—into a federal infrastructure that has a documented history of security breaches, such as the exposure of Social Security numbers. For the vulnerable populations ACCESS aims to assist, this concern is far from negligible.
Financial risks also exist. CMS innovation programs have a varied track record; a 2023 Congressional Budget Office analysis determined that the CMS Innovation Center, in its initial decade, led to an increase of $5.4 billion in federal spending rather than achieving its projected savings. Furthermore, CMS is offering lower per-patient per-month payments than many participants had anticipated, implying that the financial model is viable primarily for organizations that have extensively automated their patient interactions.
Batlivala, however, frames the reimbursement concern not as a flaw, but as an intentional design feature. He explained, “If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low.” He further clarified, “The economics only work if you're running a lean, AI-first operation.”
Pair Team reports that it currently possesses partnerships granting access to approximately 500,000 potential patients, with an ambitious goal to expand this reach to one million within the next three years.
Healthcare investors are closely monitoring these developments. Digital health funding reached its highest first-quarter total since the pandemic this year, with AI companies attracting the majority of this investment. In contrast, ACCESS has garnered minimal attention beyond specialized health tech trade publications.
The Editorial Staff at AIChief is a team of professional content writers with extensive experience in AI and marketing. Founded in 2025, AIChief has quickly grown into the largest free AI resource hub in the industry.