The Centers for Medicare & Medicaid Services has chosen 150 organizations for ACCESS, a 10-year program that goes live July 5 and, for the first time, lets federal Medicare dollars flow to AI-driven chronic care. Advancing Chronic Care with Effective, Scalable Solutions pays participants predictable amounts to manage diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety — and pays the full rate only when patients hit measurable goals such as lower blood pressure or reduced pain. Traditional Medicare reimburses on time spent with a clinician, which leaves no mechanism to pay an AI agent that monitors a patient between visits or coordinates a housing referral. ACCESS creates one.
Among the 150 participants is Pair Team, a seven-year-old company that announced its selection on April 30. Pair Team employs roughly 850 clinical professionals, runs what it describes as the largest community health workforce in California, and reports revenue above nine figures on about $30 million raised from Kleiner Perkins, Kraft Ventures, and Next Ventures. Founder Neil Batlivala calls the new payment structure the real news: "It's a payment model transformation. You just couldn't do this before."
The first cohort spans AI doctor startups, virtual nutrition therapy providers, connected device companies, and wearable makers including Whoop. Batlivala is skeptical that hardware alone addresses the population ACCESS targets. "I'm a big fan of wearables, but for a senior who's struggling with food insecurity, I don't know how much Whoop is going to be able to do," he said.
Key facts
- 01CMS selected 150 participants for ACCESS, a 10-year program launching July 5 that pays for chronic-care outcomes rather than clinician time.
- 02Pair Team employs about 850 clinical professionals, has raised roughly $30 million from Kleiner Perkins, Kraft Ventures, and Next Ventures, and reports revenue above nine figures.
- 03Pair Team's voice agent Flora, deployed nine months ago, now handles 24/7 intake, referrals, and check-ins, including hour-long patient conversations.
- 04A 2023 Congressional Budget Office analysis found the CMS Innovation Center added $5.4 billion in federal spending in its first decade rather than producing projected savings.
- 05Pair Team has access to roughly 500,000 patients through partnerships and is targeting one million within three years.
Pair Team launched in 2019 to serve patients managing chronic conditions alongside unstable housing, food insecurity, or lack of transportation — roughly one in three Americans. A peer-reviewed study in the Journal of General Internal Medicine, co-authored by Pair Team researchers, evaluated its community-integrated model for Medicaid members and reported reductions in avoidable emergency and inpatient utilization. Batlivala says one in four hospital visits and one in two ER visits don't happen when a patient is in the company's care.
“Pair Team says one in four hospital visits and one in two ER visits don't happen when a patient is in its care, a model now routed through its voice agent Flora.”— Jaeden Schafer
That model previously required large human teams. About nine months ago, Pair Team deployed a voice AI agent called Flora as its primary patient-facing interface, available 24 hours a day to handle intake, coordinate referrals, and run check-ins. The first call that shifted Batlivala's thinking involved a 67-year-old woman living out of her car, managing PTSD and congestive heart failure, who spoke with Flora for over an hour. "It was both incredible and depressing," he said. "Flora was probably the only 'person' she'd talked to in weeks about her situation."
Hour-long conversations with Flora are now routine. "That's the companionship piece," Batlivala said. "And it turns out that is truly an intervention." The use case — sustained, low-acuity engagement between visits — is precisely the work that fee-for-service Medicare has never funded.
ACCESS was designed by Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, the Innovation Center's Chief AI and Technology Officer. Sutton previously worked at the healthcare-focused fund Rubicon Founders; Shiff is a former healthcare founder. Both joined CMS under the Trump administration, and the program reflects their backgrounds: outcomes-based payments, direct-to-consumer enrollment, and explicit competition between vendors. "The government is creating swim lanes for AI innovation in traditionally regulated industries," Batlivala said. "The best solution wins, which, in regulated industries like healthcare — that's not been the case."
The risks are real. Participants will feed extraordinarily sensitive patient data — conversations about housing, disease, and mental illness — into federal infrastructure with a documented history of breaches, including exposed Social Security numbers. The financial track record is also mixed: a 2023 Congressional Budget Office analysis found the CMS Innovation Center increased federal spending by $5.4 billion during its first decade rather than producing the projected savings. CMS is paying less per patient per month than many ACCESS participants anticipated, meaning the math only works for organizations that have automated most patient interactions.
Batlivala frames the low reimbursement as deliberate. "If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low," he said. "The economics only work if you're running a lean, AI-first operation." Pair Team has partnerships covering roughly 500,000 potential patients and is targeting one million within three years.
Healthcare investors are paying attention even if generalist tech press largely is not. Digital health funding in Q1 2026 hit its highest total since the pandemic, with AI companies capturing the bulk of it. ACCESS has stayed mostly inside health-tech trade coverage, which is itself a tell about how siloed AI deployment in regulated sectors remains.
ACCESS is the closest thing yet to a federal procurement signal for AI in healthcare delivery, and the structure matters more than the dollar size of any individual contract. By paying for outcomes rather than activities, CMS has effectively told vendors that automation is allowed to substitute for clinician hours, provided the patient gets better. That changes the unit economics of every chronic-care startup pitching Medicare, and it gives an early lane to operators like Pair Team that already run AI agents in production. The next two years will show whether outcome-linked payments can scale without either bankrupting lean operators or repeating the Innovation Center's history of cost overruns — but the door to AI-native care at federal scale is now open, and 150 companies just walked through it.
Working on something we should cover, or seeing a story we missed? Send leads, documents, or feedback to hello@aichatdaily.com. For sensitive tips, see our secure tips page for Signal and PGP options.
Spotted an error? Email hello@aichatdaily.com with the URL and the issue, or read our full corrections policy.
