Nana Wu
For seven years, Neil Batlivala has been operating in the shadows of the healthcare industry. While much of Silicon Valley’s venture capital poured into concierge medicine for the wealthy or high-end wellness apps, Batlivala’s company, Pair Team, was quietly building an infrastructure for a demographic most tech companies ignore: the chronically ill, the housing-insecure, and those living at the margins of the American safety net.
Last month, that quiet, persistent work placed Batlivala at the center of a federal experiment that could redefine how the United States delivers medical care. On April 30, Pair Team was named one of 150 participants in the Centers for Medicare & Medicaid Services’ (CMS) new ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) program. Set to go live on July 5, the initiative represents a watershed moment: it is the first time the federal government is systematically testing how AI-driven medical care can function at scale.
The Paradigm Shift: From Volume to Value
At its core, the ACCESS program is a ten-year commitment by CMS to overhaul how medical providers are compensated. For decades, the traditional Medicare model has been tethered to a fee-for-service structure. Doctors are reimbursed based on the time spent with a patient or the number of procedures performed. This model is inherently hostile to innovation; it creates no financial mechanism to pay for an AI agent that monitors a patient’s glucose levels at 2:00 a.m., coordinates a housing referral, or ensures a patient has picked up their medication.
ACCESS flips this logic. It rewards health outcomes rather than activity. Under this new model, participating organizations receive predictable, bundled payments for managing specific chronic conditions—including diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. The full financial benefit is only realized when the provider meets measurable health milestones, such as blood pressure reduction or pain management.
"The government is creating swim lanes for AI innovation in traditionally regulated industries," Batlivala explained during a recent interview. "The best solution wins, which, in regulated industries like healthcare, has simply not been the case. It’s a payment model transformation. You just couldn’t do this before."
A Chronology of Care: Building the Infrastructure
Pair Team’s journey to this moment began in 2019, long before the current generative AI boom. The company was founded on a simple, if daunting, premise: you cannot improve health outcomes for the vulnerable without addressing the full context of their lives—housing, food security, and transportation.
- 2019: Pair Team launches with a focus on integrating medical, behavioral, and social care for Medicaid members in California.
- 2020–2023: The company scales its human-centric workforce, eventually employing 850 clinical professionals. It manages to reach nine-figure revenue while raising $30 million in venture capital from heavyweights like Kleiner Perkins and Kraft Ventures.
- 2023: A study co-authored by Pair Team researchers and published in the Journal of General Internal Medicine validates the model. The data shows that the company’s community-integrated approach results in a 25% reduction in hospital visits and a 50% reduction in emergency room utilization.
- Late 2023: Recognizing that human-led care is difficult to scale, Pair Team deploys "Flora," a voice-enabled AI agent.
- April 2024: CMS selects Pair Team for the ACCESS program, validating their AI-first approach on a federal scale.
The Rise of Flora: AI as a Companion
The transition from human-heavy care to an AI-augmented model proved to be the missing link for Pair Team’s growth. Flora, the company’s proprietary voice AI agent, now serves as the primary patient-facing interface. Flora handles intake, coordinates referrals, and performs the constant, repetitive check-ins that keep patients engaged between doctor visits.
Batlivala recalls a pivotal moment involving a 67-year-old patient who was living in her car while battling PTSD and congestive heart failure. She spoke with Flora for over an hour. "It was both incredible and depressing," Batlivala said. "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—and it turns out that is truly an intervention."
Supporting Data and the Competitive Landscape
The ACCESS program is not a monolith; it includes a diverse cohort of participants, ranging from AI doctor startups to wearable tech companies like Whoop. However, Batlivala remains pragmatic, if not slightly skeptical, about the "gadget-first" approach to chronic care.
"I’m a big fan of wearables, but for a senior who’s struggling with food insecurity, I don’t know how much a fitness tracker is going to do," he noted.
The financial reality of the program is equally demanding. Some critics point to a 2023 Congressional Budget Office analysis that found previous CMS innovation models actually increased federal spending by $5.4 billion over a decade rather than generating savings. Furthermore, CMS is offering lower reimbursement rates per patient than many tech startups expected.
For Batlivala, however, these low rates are a strategic 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 argues. "The economics only work if you’re running a lean, AI-first operation."
Official Perspectives: The Startup-Led CMS
The architects behind ACCESS are not traditional bureaucrats. The program was designed by Abe Sutton and Jacob Shiff of the CMS Innovation Center. Both men bring backgrounds from the startup ecosystem—Sutton as a venture capitalist and Shiff as a healthcare founder. Their influence is evident in the program’s design, which emphasizes direct-to-consumer enrollment, competition, and outcome-based incentives. By adopting the language and methodology of Silicon Valley, they are attempting to drag the sprawling federal healthcare system into the era of automation.
Implications: The Risks and the Road Ahead
Despite the optimism, the program faces significant hurdles. The primary concern is data privacy. Participants are feeding highly sensitive, intimate conversations—details about mental health, housing crises, and chronic disease—into federal infrastructure that has, in the past, suffered from major security breaches, including the exposure of provider Social Security numbers. For the vulnerable populations that ACCESS aims to serve, this is a profound risk.
There is also the question of efficacy. If the AI-first model fails to produce the promised reductions in emergency room visits, the federal government may view the ACCESS program as another costly failed experiment.
Yet, the market is watching. Digital health funding hit its highest first-quarter total since the pandemic this year, with AI-focused firms capturing the lion’s share of capital. Pair Team currently has partnerships in place to reach 500,000 patients, with a goal of one million within three years.
As the program goes live this July, the stakes are clear. If Pair Team and its peers succeed, they will have proven that AI can do more than just generate text or images; they will have demonstrated that, when properly incentivized, technology can reach the most ignored populations in the country, providing them with a level of consistent, compassionate, and efficient care that was previously deemed impossible at a federal scale.
The question remains: can an algorithm truly replace the human touch in the most fragile corners of the healthcare system? For Neil Batlivala and his team, the answer is already being written in the thousands of hours of conversation currently taking place between patients and Flora.
Laily UPN
Neng Nana
