Healthcare Innovator Sees New Hope with Medicare Program
Neil Batlivala has dedicated seven years to building a healthcare company that many in the tech world might not know about. His company, Pair Team, focuses on helping patients often overlooked by Silicon Valley. Recently, his hard work landed him in the spotlight as part of an exciting new initiative.
On April 30, Pair Team announced its acceptance into ACCESS, a Medicare program. This initiative, led by the Centers for Medicare & Medicaid Services (CMS), aims to explore how AI can improve medical care on a large scale. The program is set to launch on July 5.
Batlivala commented, “The government is paving the way for AI innovation in heavily regulated industries.” He believes that this program opens doors, allowing the best solutions to surface in healthcare, where options have been limited in the past.
ACCESS, which stands for Advancing Chronic Care with Effective, Scalable Solutions, is a decade-long project by CMS. It aims to reward healthcare providers based not just on the number of services rendered, but on actual health improvements in patients. Organizations taking part, including Pair Team, will receive payments for managing certain health conditions and only earn full rewards when patients achieve measurable health goals like reducing blood pressure or managing pain. Conditions covered include diabetes, hypertension, and even mental health issues like anxiety and depression.
One key aspect of this program is its payment structure. Traditionally, Medicare payments have depended on the amount of time spent with doctors, meaning there was no way to compensate AI tools that keep track of patients’ health between visits. With ACCESS, this can finally change.
“It’s a transformation in how we think about payments,” Batlivala explained. “This wasn’t possible in the past.”
The initial group of participants includes various companies, from AI-driven healthcare startups to makers of wearable devices. While he appreciates the innovation, Batlivala expressed skepticism about whether some of these tools, especially wearables, truly meet the needs of seniors facing food insecurity.
Pair Team launched in 2019 with a focus on individuals managing chronic health issues who also face challenges like food shortages or unstable housing. This population is significant, with about one-third of Americans experiencing similar difficulties.
The company believes that to improve health, it must consider the whole lifestyle of its patients. It now has about 850 clinicians and claims to run California’s largest community health workforce. With backing from major investors, Pair Team has raised around $30 million and generates substantial revenue.
Their approach has been supported by research. A study co-authored by Pair Team showed that their model, which combines medical and social care for patients facing homelessness and chronic illnesses, significantly reduces hospital visits.
Previously, providing this kind of care required human teams, which limited the scale of operations. Recently, they introduced a voice AI called Flora, available around the clock to help with patient check-ins and referrals. Flora’s conversations with patients have proven to be instrumental in providing companionship that leads to better healthcare outcomes.
The team behind ACCESS understands the challenges of innovation; both Abe Sutton and Jacob Shiff have backgrounds in startups. Their experience is reflected in the program’s design, which focuses on outcomes rather than just the number of services.
However, there are potential risks. Participants are handling sensitive patient information, raising concerns about data privacy. This is especially critical for the vulnerable populations ACCESS aims to support.
Additionally, financial risks exist. Reviews have shown that past CMS innovation programs have sometimes led to increased spending rather than savings. Participants have also reported lower-than-expected payments, meaning those relying on automation will fare better.
Batlivala sees this budgeting issue as part of the plan. “To truly encourage the use of AI, the reimbursement rates need to be lower,” he noted. “The economics work best when operations are efficient and AI-driven.”
Currently, Pair Team has partnerships that could reach about 500,000 potential patients, with plans to expand to a million in three years.
Investors in healthcare are paying close attention. This year, digital health funding saw its highest levels since the pandemic, particularly for AI companies. However, the ACCESS program has not gained much attention outside specialized health tech media.
