Neil Batlivala dedicated seven years to building a healthcare company that remains virtually unknown across most of the tech industry, serving a patient demographic that Silicon Valley largely overlooks. However, that work recently thrust him into a much larger arena. On April 30, his company, Pair Team, announced it had been selected as one of 150 participants in ACCESS, a Medicare program launched by the Centers for Medicare & Medicaid Services. This initiative aims to test what AI-driven medical care could look like on a federal scale, with the program going live on July 5. "The government is creating swim lanes for AI innovation in traditionally regulated industries," Batlivala told me during a Zoom call a few days later. "The best solution wins, which, in regulated industries like healthcare—that’s not been the case."

ACCESS—short for Advancing Chronic Care with Effective, Scalable Solutions—is a 10-year CMS program that tests a payment model rewarding health outcomes rather than mandatory activities, such as a set number of check-ins. Participating organizations like Pair Team receive predictable payments for managing qualifying conditions, but they only earn the full amount when patients meet measurable health goals, like lower blood pressure or reduced pain. The program covers diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. This payment structure marks a significant shift. Traditional Medicare reimburses based on time spent with a clinician, with no mechanism to pay for an AI agent that monitors patients between visits, makes check-in calls, coordinates housing referrals, or ensures medication adherence. ACCESS creates that mechanism for the first time. "It’s a payment model transformation," Batlivala said. "You just couldn’t do this before."

The first cohort includes a diverse range of participants—AI doctor startups, virtual nutrition therapy providers, connected device companies, and wearable makers like Whoop. Batlivala remains skeptical of some. "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 said, adding of his own company, "We've been building toward this for five-plus years now."

Pair Team launched in 2019 with a specific patient focus: people managing chronic conditions while also facing unstable housing, food scarcity, or lack of transportation. About a third of Americans fall into this category. The company's core premise is that improving health outcomes requires addressing the full context of a person's life. Today, it employs roughly 850 clinical professionals, operates what it describes as the largest community health workforce in California, and generates revenue above nine figures, according to Batlivala. It has raised about $30 million, backed by Kleiner Perkins, Kraft Ventures, and Next Ventures. The model has peer-reviewed evidence backing it. A study co-authored by Pair Team researchers and peer-reviewed by the Journal of General Internal Medicine evaluated Pair Team's community-integrated model, which blends medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic disease. The study showed strong patient engagement and significant reductions in avoidable emergency and inpatient utilization. Batlivala says one in four hospital visits and one in two ER visits don't happen when a patient is under his company's care. But for years, delivering that level of care required human teams, limiting how fast and cheaply it could scale. Then, about nine months ago, Pair Team deployed a voice AI agent called Flora as its primary patient-facing interface. Flora operates 24 hours a day, handles intake, coordinates referrals, and conducts check-ins that keep patients engaged between clinical visits. The first call that shifted Batlivala's thinking was with a 67-year-old woman living out of her car, managing PTSD and congestive heart failure. She spoke with Flora for over an hour. "It was both incredible and depressing," Batlivala told me. "Flora was probably the only 'person' she'd talked to in weeks about her situation." Now, hour-long conversations with Flora are routine. "That's the companionship piece," he said. "And it turns out that is truly an intervention."

The architects of ACCESS are former startup operators themselves. The program was designed by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief AI and Technology Officer of the CMS Innovation Center. Sutton previously worked as a venture capitalist at a healthcare fund called Rubicon Founders, while Shiff is a former healthcare founder. Both joined CMS under the Trump administration, and their startup backgrounds are reflected in the program's design: outcome-based payments, direct-to-consumer enrollment, and a deliberate push for competition. There are real risks. Participants are feeding extraordinarily sensitive patient data—intimate conversations about housing, diseases, and mental illness—into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS aims to serve, this is a practical concern. Financial risks also exist. The track record of CMS innovation programs is mixed. 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. CMS is also paying less per patient per month than many participants anticipated, meaning the math only works for organizations that have fully automated most patient interactions. Batlivala views the reimbursement concern as a feature, not a bug. "If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low," he told me. "The economics only work if you're running a lean, AI-first operation."

Pair Team says it currently has partnerships in place that give it access to roughly 500,000 potential patients, with a goal of reaching a million within three years. Healthcare investors have been watching this closely. Digital health funding hit its highest Q1 total since the pandemic this year, with AI companies capturing the bulk of it. But ACCESS has barely registered outside health tech trade press.