Neil Batlivala has been developing a healthcare company called Pair Team for seven years, focusing on a patient demographic often overlooked by Silicon Valley. Recently, Pair Team was accepted into the Medicare ACCESS program, a federal initiative to explore AI-driven healthcare, making it one of 150 chosen participants. ACCESS is a 10-year project by the Centers for Medicare & Medicaid Services (CMS) testing a payment model that ties remuneration to health outcomes rather than specific activities. This program allows payment for AI-driven patient management, a first-time innovation.
ACCESS encompasses conditions like diabetes and chronic kidney disease, emphasizing a shift from traditional reimbursement models which focus on clinician time to one supporting AI monitoring tools. The program’s structure represents a significant transformation in how healthcare services are funded. Pair Team initially served patients with chronic conditions aggravated by socioeconomic issues like unstable housing. It has since scaled up its operations significantly, supported by $30 million in funding.
The organization has launched Flora, a voice AI agent, to engage patients continuously, marking a significant evolution from resource-heavy human teams. Flora’s impact was particularly noted after an in-depth conversation with a patient managing multiple health issues while living out of her car.
ACCESS, developed by former startup leaders, brings unique risks concerning data privacy and financial viability. The CMS’s history of breaches raises concerns about data security, and the program’s financial viability is uncertain due to lower-than-expected reimbursement rates. Nevertheless, Batlivala sees the low rates as an incentive for AI-driven efficiency.
Pair Team currently has access to about 500,000 potential patients, aiming to double that number in three years. Despite the potential impact of the ACCESS program, it has largely remained unnoticed outside the health tech industry, even as overall digital health investments soar, particularly in AI.