Neil Batlivala has spent seven years building a healthcare company that most of the tech industry has never heard of and that serves a patient population that most of Silicon Valley ignores. But in the past month, that job has put him at the center of something much bigger.
His company, Couple groupit was announced on April 30 that it was accepted in ACCESSa Medicare program — as one of 150 participants selected by the Centers for Medicare & Medicaid Services to test what AI-powered healthcare could look like on a federal scale. The program goes live on July 5.
“Government is creating swimming lanes for AI innovation in traditionally controlled industries,” he told me on a Zoom call a few days later. “The best solution wins, which, in regulated industries like healthcare — that’s not the case.”
ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — is a 10-year CMS program testing a payment model that rewards health outcomes rather than required activities (such as a certain number of check-ins). Participating organizations like Pair Team receive predictable payments for managing qualifying conditions and earn the full amount only when patients achieve measurable health goals, such as lower blood pressure or reduced pain. It covers diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety.
This payment structure is the real news.
Traditional Medicare reimburses based on time spent with a clinician. There is no payment mechanism for an AI agent monitoring a patient between visits, calling to check in, coordinating a housing referral, or making sure someone gets their medication. ACCESS creates this mechanism for the first time.
“It’s a transformation of the payment model,” Batlivala said. “You just couldn’t do that before.”
The first cohort covers a wide range of participants — AI doctor startups, virtual nutrition therapy providers, connected device companies and wearable device makers like Whoop. Batlivala is skeptical about some of them.
“I’m a big fan of wearables, but for an elderly person struggling with food insecurity, I don’t know how much Whoop will be able to do,” he said, adding of his own company, “We’ve been building toward this for five-plus years.”
Pair Team started in 2019 with a specific kind of patient in mind: people managing chronic conditions who also faced unstable housing, too little food, or a lack of transportation. About a third of Americans fall somewhere in this category.
The company’s premise was that you can’t improve health outcomes without addressing the full context of someone’s life. It now employs about 850 clinical professionals, operates what it describes as the largest community health workforce in California and, per Batlivala, generates more than nine figures in revenue. It has raised about $30 million, backed by Kleiner Perkins, Kraft Ventures and Next Ventures.
The model has peer-reviewed evidence behind it. A study co-authored by researchers from the Couples Group and peer-reviewed Journal of General Internal Medicineevaluated Pair Team’s community-based model, which combines medical, behavioral, and social care for Medicaid members with high rates of homelessness, severe mental illness, and chronic illness, and demonstrated strong patient engagement and significant reductions in emergency avoidance and hospitalization use. Batlivala says one in four hospital visits and one in two ER visits are not made while a patient is under his company’s care.
But for years, providing this level of care required teams of people, which limited how quickly and cheaply it could be scaled up. Then, about nine months ago, the Pair Team developed a voice AI agent called Flora as the primary patient-facing interface. Flora is available 24 hours a day, handling intake, coordinating referrals and doing the check-ins that keep patients engaged between clinic visits.
The first call that changed his thinking was with a 67-year-old woman living out of her car who was managing PTSD and congestive heart failure. Talked to Flora for over an hour. “It was unbelievable and depressing,” Batlivala told me. “Flora was probably the only ‘person’ she had talked to in weeks about her condition.” Now, hour-long conversations with Flora are routine. “That’s the companionship part,” he said. “And it turns out it really is an intervention.”
The architects of ACCESS are themselves former startup operators. 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 was previously an entrepreneur at a healthcare fund called Rubicon Founders. Shiff is a former health care founder. Both joined CMS under the Trump administration, and their startup backgrounds are reflected in the program’s design: outcomes-based payments, direct-to-consumer enrollment and a deliberate push for competition.
There are real risks. Participants are feeding highly sensitive patient data — intimate conversations about housing and illness and mental illness — into a federal infrastructure with a documented history of breaches such as exposed social security numbers. For the vulnerable populations ACCESS is designed to serve, this is not an insurmountable problem.
There are also financial risks. The track record of CMS innovation programs is mixed. Congressional Budget Office for 2023 analysis found that the CMS Innovation Center increased federal spending by $5.4 billion over the first decade instead of producing the projected savings. CMS also pays less per patient per month than many participants expected, meaning the math only works for organizations that have fully automated most of their interactions with patients.
Batlivala’s response to the compensation concern is that it’s a feature, not a bug. “If you want to create a model that really incentivizes the use of AI, the compensation rates have to be low,” he told me. “Finance only works if you run a lean, AI-first operation.”
Pair Team says it currently has partnerships that give it access to about 500,000 potential patients, and that it wants to reach one million within three years.
Healthcare investors are watching this closely. Digital health financing has struck higher total Q1 from the pandemic this year, with AI companies taking up most of it. But ACCESS has barely registered outside of the health technology business.
When you purchase through links in our articles, we may earn a small commission. This does not affect our editorial independence.
