Medicare quietly launched one of the most significant shifts in American healthcare. Most of the tech industry missed it entirely. Called ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — this 10-year Centers for Medicare & Medicaid Services (CMS) program creates, for the first time, a federal payment pathway specifically designed for AI-powered patient care. It goes live on July 5, 2026.
What Is the ACCESS Program?
ACCESS is a CMS Innovation Center program. It selects participating organizations and pays them to manage patients with chronic conditions — diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. Crucially, participants earn full payment only when patients meet measurable health goals. Lower blood pressure qualifies. Reduced pain qualifies. This outcome-based structure is a fundamental departure from traditional Medicare reimbursement.
How Traditional Medicare Has Always Worked
Traditional Medicare pays for clinician time. A doctor sees a patient. Medicare reimburses the visit. Nothing in that model accounts for what happens between appointments. No mechanism existed to pay for an AI agent that monitors a patient at home, coordinates a housing referral, or confirms medication pickup. ACCESS creates that mechanism for the first time.
Why the Payment Structure Changes Everything
The payment model itself is the real breakthrough. “It’s a payment model transformation,” said Neil Batlivala, CEO of Pair Team, one of 150 organizations accepted into ACCESS. “You just couldn’t do this before.” Furthermore, the low reimbursement rates are intentional. “If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low,” Batlivala explained. “The economics only work if you’re running a lean, AI-first operation.” Organizations that automate most patient interactions will thrive. Those relying heavily on human staff will struggle to break even.
Pair Team and the Patient Population Silicon Valley Ignores
Pair Team launched in 2019 with a clear mission. It targets patients managing chronic conditions alongside housing instability, food insecurity, or lack of transportation. Roughly one-third of Americans fall into this category. Silicon Valley largely ignores them. Yet Pair Team has built the largest community health workforce in California. Today, it employs approximately 850 clinical professionals and generates nine-figure annual revenue. Investors including Kleiner Perkins, Kraft Ventures, and Next Ventures have backed it with around $30 million in total funding.
Peer-Reviewed Evidence Behind the Model
Pair Team’s approach carries academic validation. A study co-authored by its researchers and published in the Journal of General Internal Medicine evaluated its community-integrated model — blending medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic disease. Results showed strong patient engagement. Moreover, the study found significant reductions in avoidable emergency and inpatient visits. Batlivala reports that one in four hospital visits and one in two ER visits do not occur when patients receive Pair Team’s care.
Flora: The AI Agent at the Front Line
Nine months ago, Pair Team deployed a voice AI agent named Flora as its primary patient-facing interface. Flora operates 24 hours a day. It handles patient intake, coordinates referrals, and conducts regular check-ins between clinical visits. One call reshaped Batlivala’s thinking about what AI could do. A 67-year-old woman living out of her car, managing PTSD and congestive heart failure, spoke with Flora for over an hour. “It was both incredible and depressing,” Batlivala said. “Flora was probably the only ‘person’ she’d talked to in weeks.” Hour-long conversations with Flora are now routine. “That’s the companionship piece,” he noted. “And it turns out that is truly an intervention.”
Who Designed ACCESS — and Why It Matters
ACCESS carries startup DNA. Abe Sutton, Director of the CMS Innovation Center, previously worked as a venture capitalist at healthcare fund Rubicon Founders. Jacob Shiff, the Center’s Chief AI and Technology Officer, is a former healthcare founder. Both joined CMS under the Trump administration. Their backgrounds show clearly in the program’s design: outcome-based payments, direct-to-consumer enrollment, and deliberate competition among participants. “The government is creating swim lanes for AI innovation in traditionally regulated industries,” Batlivala said. “The best solution wins — and in regulated industries like healthcare, that’s not been the case.”
Real Risks: Data, Finance, and Scale
ACCESS carries genuine risks. Participants collect extraordinarily sensitive patient data. Conversations cover housing struggles, mental illness, and chronic disease. This data flows into federal infrastructure with a documented history of breaches, including previously exposed Social Security numbers. For vulnerable populations, these are not abstract concerns.
Financial risks also exist. A 2023 Congressional Budget Office analysis found that the CMS Innovation Center increased federal spending by $5.4 billion during its first decade — rather than producing projected savings. Additionally, reimbursement rates sit below what many participants anticipated. The program’s math only works for organizations that have automated most patient interactions.
What This Means for Health Tech Investors
Healthcare investors are paying close attention. Digital health funding reached its highest Q1 total since the pandemic this year. AI companies captured most of that capital. Yet ACCESS has barely registered outside health tech trade press. Pair Team currently holds partnerships giving it access to roughly 500,000 potential patients. Its goal is to reach one million within three years. For AI startups watching from the sidelines, the window to engage is already open.
