Neil Batlivala has spent seven years building Pair Team, a healthcare company focused on patients with chronic conditions who also face unstable housing, food insecurity, or transportation barriers. On April 30, Pair Team announced it had been chosen as one of 150 participants in ACCESS (Advancing Chronic Care with Effective, Scalable Solutions), a Medicare pilot run by the Centers for Medicare & Medicaid Services (CMS). The program is set to begin on July 5.
What is ACCESS?
ACCESS is a ten-year CMS program testing an outcomes-based payment model: instead of reimbursing based on volume of services (for example, number of visits), the program rewards measurable patient health outcomes. Participant organizations receive predictable funding for treating eligible chronic conditions, but the full payment is contingent on patients meeting measurable goals such as lower blood pressure or reduced pain. The pilot covers conditions including diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety.
What’s new in the model?
The key innovation is the payment structure. Traditional Medicare reimburses for clinician time and visits, and currently lacks a mechanism to pay for services such as an AI agent that monitors patients between visits, conducts phone check-ins, coordinates housing support, or ensures medication pickup. ACCESS creates a first federal pathway for funding those kinds of services. Batlivala described the change as a "financing model shift," noting such approaches were not previously feasible under existing reimbursement rules.
Who is participating and what technologies are involved?
The initial cohort is diverse: AI clinician startups, virtual nutrition therapy providers, companies building connected devices, and wearable manufacturers like Whoop. Batlivala said he is skeptical about some technologies’ fit for certain patients — for example, wearables may have limited benefit for an elderly person facing food insecurity. Pair Team, by contrast, says it has been building toward this model for more than five years. About nine months ago, the company launched Flora, a voice-based AI agent that serves as the primary patient engagement interface. Flora is available 24/7, handles data collection, coordinates referrals, and performs the regular outreach interactions that keep patients engaged between medical visits.
Pair Team’s model and scale
Pair Team began in 2019 targeting a specific vulnerable population: people with chronic conditions who also face housing instability or other social needs. The company notes that roughly one in three Americans fall into this broader category. Pair Team employs about 850 healthcare workers, claims to operate California’s largest community health workforce network, and reports annual revenues exceeding $100 million. To date the company has raised roughly $30 million from investors including Kleiner Perkins, Kraft Ventures, and Next Ventures.
Evidence base and outcomes
There is peer-reviewed evidence behind the model. Pair Team researchers were co-authors on a Journal of General Internal Medicine study evaluating the company’s community-integrated care model. That integrated health, mental health, and social care approach focused on Medicaid enrollees with high rates of homelessness, severe mental illness, and chronic conditions. The study showed strong patient engagement and significant reductions in preventable emergency and inpatient care. Batlivala claims that one in four hospital visits and one in two emergency department visits can be avoided when patients receive care through his company.
Scaling with AI
Historically, delivering that level of wraparound care required human teams, limiting how quickly and cheaply the model could scale. Introducing Flora aims to automate many interactions and expand reach cost-effectively. Batlivala recounts a pivotal early conversation: a 67-year-old woman living in her car with PTSD and congestive heart failure spoke with Flora for more than an hour, an interaction he described as both remarkable and sobering. Such hour-long conversations are now routine and, according to the company, represent meaningful therapeutic and social interventions.
Risks: privacy and finances
ACCESS also raises material risks. Participants will feed highly sensitive patient data — including intimate details about housing, illness, and mental health — into a federal infrastructure that has a history of documented privacy incidents, including leaked Social Security numbers. For the vulnerable populations targeted by ACCESS, those risks are concrete.
There are financial risks as well. The Congressional Budget Office (CBO) found in a 2023 analysis that the CMS Innovation Center increased federal spending by $5.4 billion in its first decade rather than delivering expected savings. ACCESS pays participants less per patient per month than many organizations anticipated, meaning the model is economically viable primarily for providers that have already automated a large share of patient interactions. Batlivala argues the lower payment rates are intentional: to incentivize AI-driven, lean operating models, the reimbursement must be relatively low so that the economics favor streamlined, AI-centered operations.
Outlook and investor attention
Pair Team currently has partnerships that give it access to approximately 500,000 potential patients and aims to reach one million patients within three years. Health investors are watching closely: healthcare tech funding in the first quarter of this year reached its highest level since the pandemic, and AI companies captured a large share of that investment. The ACCESS pilot has drawn attention in health-tech outlets but remains relatively under the radar in broader public discourse.
How Pair Team and other ACCESS participants perform will help determine whether federal, outcomes-based reimbursement tied to AI-enabled care can reshape services for vulnerable, chronically ill populations — while highlighting the need to manage privacy and financial risks.
