Pair Team joins CMS program to test AI-driven medical care

On April 30, California-based healthcare company Pair Team announced its acceptance into ACCESS, a program run by the Centers for Medicare & Medicaid Services (CMS), a US federal agency. Pair Team is one of 150 participants chosen by CMS to participate in the 10-year program, which is scheduled to go live on July 5. The initiative, officially named Advancing Chronic Care with Effective, Scalable Solutions (ACCESS), is designed to test a payment model that rewards health outcomes rather than required activities. Pair Team, which launched in 2019, focuses on people managing chronic conditions who were also dealing with unstable housing, too little food, or lack of transportation.

Traditional Medicare—the US federal health insurance program—reimburses providers based on time spent with a clinician, leaving no mechanism to pay for automated patient monitoring between visits. The ACCESS program changes this by establishing outcome-based payments, allowing organizations to be reimbursed for deploying AI tools to manage patient care. For example, Pair Team utilizes a voice AI agent named Flora to handle intake, coordinate referrals, and conduct check-ins. Neil Batlivala, founder and CEO of Pair Team, described the shift: “It’s a payment model transformation.”

The company has scaled its operations significantly since its launch. Key financial and operational metrics for Pair Team include:

• Funding: Raised about $30 million from investors including Kleiner Perkins, Kraft Ventures, and Next Ventures.
• Revenue: Generates revenue above nine figures, according to Batlivala.
• Staffing: Employs roughly 850 clinical professionals.
• Patient Reach: Holds partnerships giving it access to roughly 500,000 potential patients, with a target to reach a million patients within three years.

Despite the opportunities, the program introduces notable regulatory and financial risks. On the data security front, participants will feed highly sensitive patient information—including details on Medicaid (the US public health program) members dealing with homelessness, serious mental illness, and chronic disease, as well as individuals managing PTSD and congestive heart failure—into a federal infrastructure with a history of data breaches that exposed Social Security numbers. Financially, the track record of CMS innovation programs is mixed. The Congressional Budget Office reported that the CMS Innovation Center increased federal spending by $5.4 billion during its first decade instead of producing savings. The low reimbursement rates under the program mean the math only works for organizations that have fully automated most of their patient interactions. Batlivala also expressed skepticism about some participants, such as wearable maker Whoop, stating that while he is a fan of wearables, he does not know how much Whoop can do for a senior struggling with food insecurity.

Why it matters

The ACCESS program introduces a new payment model that rewards health outcomes rather than required activities, creating a mechanism to reimburse AI agents for patient monitoring. This shift incentivizes AI-first operations in healthcare, a sector where such reimbursement mechanisms previously did not exist.