Neil Batlivala has dedicated seven years to developing a healthcare company that remains largely unknown in the tech industry, focusing on a patient base often overlooked by Silicon Valley. Recently, his work catapulted him into a significant initiative.
On April 30, his company, Pair Team, announced its acceptance into the Medicare ACCESS program, one of 150 participants selected by the Centers for Medicare & Medicaid Services (CMS) to explore the potential of AI-driven healthcare on a national scale. This groundbreaking program is set to launch on July 5.
Batlivala noted, "The government is creating pathways for AI innovation in traditionally regulated sectors. In healthcare, the best solutions will emerge, which hasn't always been the case."
ACCESS, which stands for Advancing Chronic Care with Effective, Scalable Solutions, is a decade-long CMS initiative that tests a payment model rewarding health outcomes over traditional activity-based metrics. Organizations like Pair Team will receive consistent payments for managing qualifying conditions, earning full compensation only when patients achieve specific health goals, such as improved blood pressure or reduced pain. The program covers chronic conditions like diabetes, hypertension, and obesity.
This innovative payment structure marks a significant shift. Unlike traditional Medicare, which compensates based on clinician time, ACCESS introduces a mechanism to reimburse AI agents that monitor patients between visits, coordinate care, and ensure medication adherence. Batlivala described this as a transformative change, stating, "You just couldn't do this before."
The first cohort includes a diverse array of participants, from AI healthcare startups to virtual nutrition therapy providers and wearable technology companies. Batlivala expressed skepticism about some participants, emphasizing the importance of context in healthcare delivery.
Founded in 2019, Pair Team targets individuals managing chronic conditions who also face challenges like unstable housing or food insecurity, a demographic that includes about a third of Americans. The company believes that improving health outcomes requires addressing the broader context of a patient's life.
Currently, Pair Team employs around 850 clinical professionals and claims to operate California's largest community health workforce, generating significant revenue and securing approximately $30 million in funding from notable investors.
Research published in the Journal of General Internal Medicine supports the effectiveness of Pair Team's community-integrated model, demonstrating strong patient engagement and notable reductions in emergency visits. Batlivala noted that under their care, one in four hospital visits and one in two ER visits are prevented.
To enhance scalability, Pair Team recently introduced a voice AI agent named Flora, which manages patient interactions, intake processes, and follow-up check-ins, available around the clock. Batlivala recounted an impactful conversation Flora had with a vulnerable patient, highlighting the AI's role in providing essential companionship.
ACCESS's architects, including Abe Sutton and Jacob Shiff, both with startup backgrounds, designed the program to encourage competition and consumer engagement through outcome-based payments.
While the initiative carries potential risks, including the handling of sensitive patient data, Batlivala believes the reimbursement model incentivizes an AI-first approach, essential for sustainable healthcare innovation. Currently, Pair Team aims to expand its reach to one million patients within three years, attracting attention from healthcare investors as digital health funding rises.
