Medicare ACCESS – Medicare’s ACCESS program will pay for measurable health outcomes, creating new space for AI-driven care between visits.
A new Medicare payment experiment is putting AI where it has often struggled to fit: in the messy. ongoing work between clinician visits.. The CMS program. ACCESS. starts July 5—and for one relatively under-the-radar healthcare company. it could redefine what “care management” is financially rewarded for.
Pair Team. a healthcare organization founded by Neil Batlivala. was accepted into ACCESS as one of 150 participants chosen by the Centers for Medicare & Medicaid Services to test what AI-driven medical care could look like at federal scale.. Batlivala. who has spent seven years building a company serving patients most of Silicon Valley has largely overlooked. said the government is effectively creating lanes for AI innovation inside industries that have long been heavily regulated.
The real shift is the structure of the payment.. ACCESS is a 10-year CMS program testing a model that rewards health outcomes rather than forcing providers to complete specific tasks—such as hitting a prescribed number of check-ins.. Participating organizations receive predictable payments for managing qualifying conditions. and they earn the full amount only when patients achieve measurable goals.. Those goals can include improvements in health markers such as lower blood pressure or reduced pain.
ACCESS is aimed at several chronic conditions and related mental health needs. including diabetes. hypertension. chronic kidney disease. obesity. depression. and anxiety.. That range matters because it signals CMS isn’t limiting the experiment to narrow, easily measured clinical workflows.. Instead. the model is designed around sustained progress—where care management. follow-through. and patient engagement often determine whether outcomes actually move.
That’s also why traditional Medicare reimbursement is a poor match for the way many AI tools are built to work.. Conventional Medicare reimbursement has been anchored to time spent with clinicians.. The program creates a mechanism to pay for support that happens between scheduled appointments. including monitoring. patient outreach. referral coordination. and ensuring medication is taken—tasks that resemble what an AI agent can do continuously.
Within the first cohort. ACCESS includes a wide mix of participants. from AI “doctor” startups to virtual nutrition therapy providers. connected device companies. and wearable makers such as Whoop.. Batlivala expressed skepticism about how much certain consumer health devices can help in situations where the challenge isn’t just health behavior. but basic stability—food insecurity and housing vulnerability in particular.. He also positioned Pair Team’s own approach as something the company had been building toward for years.
Pair Team launched in 2019 with a focused thesis: chronic health outcomes can’t be improved without addressing the surrounding life conditions that derail treatment.. The company targeted people managing chronic conditions while also facing unstable housing. too little food. or lack of transportation—an overlap Batlivala characterized as affecting roughly a third of Americans.
Today, Pair Team employs roughly 850 clinical professionals and runs what it describes as the largest community health workforce in California.. The company reports revenue above nine figures and says it has raised about $30 million. with backing that includes Kleiner Perkins. Kraft Ventures. and Next Ventures.. Those details point to the scale required to serve high-need populations while still building room for automation.
Pair Team’s approach is not based only on operational experience; it also points to peer-reviewed evidence.. A study co-authored by Pair Team researchers and peer-reviewed by the Journal of General Internal Medicine evaluated its community-integrated model for Medicaid members with high rates of homelessness. serious mental illness. and chronic disease.. The study reported strong patient engagement and significant reductions in avoidable emergency and inpatient utilization.. Batlivala says the effect is substantial. with one in four hospital visits and one in two ER visits not happening when patients are in his company’s care.
Scaling that model. however. previously depended heavily on human teams—an ingredient that can cap how quickly and cheaply services expand.. That constraint is part of the reason automation is central to Pair Team’s current strategy.. About nine months ago, the company deployed a voice AI agent named Flora as its primary patient-facing interface.
Flora is presented as available 24 hours a day and responsible for key “in-between-visit” functions such as intake. coordinating referrals. and running the check-ins that keep patients engaged between clinical visits.. Pair Team says the aim is to maintain continuity of support without requiring constant human staffing.
Batlivala described a turning point that illustrated the difference AI made in practice.. He recalled a call with a 67-year-old woman living out of her car while managing PTSD and congestive heart failure.. Flora spoke with her for more than an hour. and Batlivala said the experience was both incredible and depressing—because Flora may have been the only “person” she had talked to in weeks about her situation.. He added that hour-long conversations with Flora became routine and framed the companionship aspect as an intervention rather than a side effect.
The ACCESS program itself was designed by people with startup backgrounds. and that pedigree shows up in the model’s mechanics.. CMS program architects include Abe Sutton. Director of the CMS Innovation Center. and Jacob Shiff. Chief AI and Technology Officer of the same center.. The pair previously worked in venture and healthcare startups. and both have histories reflected in ACCESS’s emphasis on outcome-based payments. direct-to-consumer enrollment. and a deliberate push for competition.
While ACCESS is built to encourage innovation, it carries serious risks—particularly around data.. Participants are feeding extraordinarily sensitive patient information into federal infrastructure. including intimate details about housing instability and diseases alongside mental illness.. Batlivala’s concerns reflect a broader reality: the federal environment has a documented history of breaches. including exposed Social Security numbers.. For the vulnerable populations ACCESS is intended to serve, those risks are not theoretical.
There are also financial risks tied to how CMS innovation programs perform.. A 2023 Congressional Budget Office analysis found that the CMS Innovation Center increased federal spending by $5.4 billion during its first decade rather than producing projected savings.. In addition. CMS is paying less per patient per month than many participants expected. which Batlivala argues changes the economics: the business case works mainly for organizations that have automated most of the interactions needed to deliver the model.
Batlivala’s response is that the structure is meant to drive automation, not just reimburse it.. He framed the reimbursement approach as “a feature. not a bug. ” arguing that reimbursement rates must be low enough to truly incentivize the use of AI. and that the economics only hold when operations are lean and AI-first.
Pair Team says it already has partnerships that could give it access to about 500. 000 potential patients. and that it wants to reach a million within three years.. That target underscores how aggressively the program could scale the winner-take-most dynamic in outcome-based care. especially if automated patient interfaces can reliably sustain engagement.
Outside of health tech circles, however, ACCESS appears to be attracting less attention than it might.. Investors have been watching digital health closely as funding in the sector reached its highest Q1 total since the pandemic this year. with AI companies capturing much of it.. Yet the ACCESS effort has barely registered beyond health tech trade coverage. leaving much of the broader tech industry—and much of the AI world—largely unaware that Medicare has quietly created new rules for what it will pay for.
For healthcare and AI builders, the countdown to July 5 isn’t just another pilot.. It’s a test of whether AI-driven support can be tied to measurable outcomes at federal scale—while also surviving the data sensitivities and operational realities that come with serving some of the most medically complex people in the system.
Medicare ACCESS AI healthcare payment outcome-based care CMS Innovation Center voice AI for patients health data privacy