Neil Batlivala spent seven years building a healthcare company that served patients that most of the tech industry had never heard of and that most of Silicon Valley ignored. But last month, that job put him at the center of a bigger case.
His company, Double TeamIt was announced on April 30 was accepted included INTRODUCTIONThe Medicare program — as one of 150 participants selected by the Centers for Medicare & Medicaid Services to test what AI-powered health care could look like at the federal level. The program will be broadcast on July 5.
“Government is creating swimming lanes for AI innovation in traditionally regulated industries,” he said during a Zoom call a few days later. “The best solution wins, which was not the case in regulated industries like healthcare.”
ACCESS — Improving Chronic Care with Effective, Scalable Solutions — is a 10-year-old CMS program piloting a payment model that rewards health outcomes from required activities (such as a certain number of enrollments). Participating organizations like Pair Team receive predictable payments for managing eligible conditions and only earn the full amount when patients meet measurable health goals, such as lower blood pressure or reduced pain. This includes diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety.
That fee structure is the real news.
Traditional Medicare reimburses based on the time spent with a clinician. There’s no mechanism to pay for an AI agent that monitors a patient between visits, calls check-ins, coordinates a housing referral, or makes sure someone takes their medication. ACCESS creates this mechanism for the first time.
“This is a transformation of the payment model,” Batliwala said. “You couldn’t do that before.”
The first cohort includes a wide range of participants – AI doctor startups, virtual nutrition therapy providers, connected device companies and wearable manufacturers like Whoop. Batliwala is skeptical of some of them.
“I’m a big fan of wearables, but for a senior struggling with food insecurity, I don’t know how much Whoop can do,” he said, adding of his company: “We’ve been building on this for over five years now.”
Pair Team launched in 2019 with a specific patient in mind: people managing chronic conditions who also deal with unstable housing, too little food, or lack of transportation. About a third of Americans fall into this category.
The company’s guiding principle was that it is impossible to improve health outcomes without addressing the full context of someone’s life. It now employs about 850 clinical professionals, managing what it describes as the largest public health workforce in California, and generating more than nine figures, according to Batliwal. It has raised nearly $30 million along the way, including Kleiner Perkins, Kraft Ventures and Next Ventures.
There is peer-reviewed evidence behind the model. A peer-reviewed study co-authored by Pair Team researchers Journal of General Internal Medicineevaluated Pair Team’s community-integrated model, which combines medical, behavioral, and social care for Medicaid members with high levels of homelessness, serious mental illness, and chronic illness, and demonstrated strong patient engagement and significant reductions in preventable emergency and inpatient use. Batliwala says that one out of four hospital visits and two out of every two ER visits do not occur when the patient is in their own company.
But for years, providing this level of care required teams of people, which limited how quickly and cheaply it could scale. Then, about nine months ago, the Pair Team deployed a voice AI agent named Flora as the primary patient-facing interface. Flora is available 24 hours a day, managing admissions, coordinating referrals and running check-ins to keep patients busy between clinical visits.
The first call that changed his mind was with a 67-year-old woman living out of her car, managing PTSD and heart failure. He talked to Flora for over an hour. “It was both incredible and depressing,” Batliwala told me. “Flora was probably the only ‘person’ he talked to about his condition in weeks.” Hour-long conversations with Flora are now commonplace. “It’s a companion piece,” he said. “And it turns out that it really is an intrusion.”
The architects of ACCESS are themselves former startup operators. The program was developed by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief Artificial Intelligence and Technology Director of the CMS Innovation Center. Sutton was previously a venture capitalist at Rubicon Founders, a healthcare fund. Schiff is a former healthcare founder. Both joined CMS under the Trump administration, and their startup backgrounds were reflected in the program’s design: outcomes-based payments, direct-to-consumer enrollment, and a targeted push for competition.
There are real risks. Participants disclosed unusually sensitive patient information—housing and intimate conversations about illness and mental illness—to federal infrastructure with a documented history of violations, including disclosed Social Security numbers. For the vulnerable population ACCESS is designed to serve, this is not a practical concern.
There are also financial risks. The track record of CMS innovation programs is mixed. 2023 Congressional Budget Office analysis CMS found that the Center for Innovation increased federal spending by $5.4 billion in its first decade, far short of the projected savings. CMS also pays less per patient per month than many participants expect, which means the math only works for organizations that fully automate patient interactions.
Batliwala’s response to compensation concerns is that it’s a feature, not a bug. “If you want to build a model that really incentivizes the use of AI, reimbursement rates have to be low,” he said. “The economy only works if you have a lean, AI-powered first operation.”
Pair Team said it currently has partnerships that provide access to about 500,000 potential patients and wants to reach one million within three years.
Healthcare investors are watching all of this closely. Funding for digital health has hit it the highest Q1 total Since the pandemic this year, AI companies have taken over much of it. Meanwhile, ACCESS barely registered outside of the health technology trade press.
When you purchase through links in our articles, we may earn a small commission. This does not affect our editorial independence.
