Neil Batlivala: A Visionary in AI-Driven Healthcare
Neil Batlivala has spent seven years building a healthcare company that most tech companies have never heard of and that serves a patient population largely ignored in Silicon Valley. But last month, that work put him at the center of something much bigger.
Pair Team and the ACCESS Program
His company, Pair Team, announced April 30 that it had been accepted into ACCESS, a Medicare program, as one of 150 participants selected by the Centers for Medicare & Medicaid Services to test what AI-driven medical care might look like at the federal level. The program goes online on July 5th.
“The government is creating swimming lanes for AI innovation in traditionally regulated industries,” he told me on a Zoom call a few days later. “The best solution wins, which has not been the case in regulated industries like healthcare.”
The Structure and Significance of ACCESS
ACCESS – Advancing Chronic Care with Effective, Scalable Solutions – is a 10-year CMS program testing a payment model that rewards health outcomes and non-essential activities (such as a certain number of check-ins). Participating organizations like Pair Team receive predictable payments for managing qualifying conditions and only earn the full amount when patients achieve measurable health goals, such as: B. lower blood pressure or less pain. It covers diabetes, high blood pressure, chronic kidney disease, obesity, depression, and anxiety.
This payment structure is the real news.
Traditional Medicare reimbursements are based on time spent with the doctor. There is no mechanism to pay an AI agent to monitor a patient between visits, call for check-in, coordinate a housing transfer, or arrange for someone to pick up their medications. ACCESS creates this mechanism for the first time.
“It’s a transformation of the payment model,” Batlivala said. “That was simply not possible before.”
Diverse Participants and Challenges
The first cohort includes a wide range of participants – AI doctor startups, virtual nutritional therapy providers, connected device companies, and wearable device manufacturers like Whoop. Batlivala is skeptical about some of them.
“I’m a big fan of wearables, but for a senior struggling with food insecurity, I don’t know how much Whoop can do,” he said, adding of his own company, “We’ve been working toward this for over five years.”
Pair Team’s Unique Approach
Pair Team was launched in 2019 with a specific type of patient in mind: people with chronic illnesses who also struggled with unstable housing, lack of food, or lack of transportation. About a third of Americans fall somewhere in this category.
The company’s premise was that you cannot improve health outcomes without considering the entire context of a person’s life. The company currently employs about 850 clinical professionals, has what it believes is the largest community health workforce in California, and generates more than nine figures in revenue, according to Batlivala. Around $30 million was raised, including from Kleiner Perkins, Kraft Ventures, and Next Ventures.
The model is based on peer-reviewed evidence. A study co-authored by Pair Team researchers and peer-reviewed by the Journal of General Internal Medicine evaluated Pair Team’s community-integrated model, which combines medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic illness. According to Batlivala, one in four hospital visits and one in two emergency room visits do not occur when a patient is in their company’s care.
The Role of AI in Scaling Care
But providing this level of care has required human teams for years, limiting rapid and cost-effective scaling. Then, about nine months ago, Pair Team deployed a voice AI agent named Flora as its primary patient interface. Available 24 hours a day, Flora manages admissions, coordinates referrals, and handles check-ins to keep patients busy between clinic visits.
The first call that changed his thinking was with a 67-year-old woman living in her car who was suffering from post-traumatic stress disorder and heart failure. She spoke to Flora for over an hour. “It was incredible and depressing at the same time,” Batlivala told me. “Flora was probably the only ‘person’ she had spoken to about her situation in weeks.” Hours of conversation with Flora are now the order of the day. “That’s the camaraderie piece,” he said. “And it turns out it’s actually an intervention.”
Architects of ACCESS
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 a venture capitalist at a healthcare fund called Rubicon Founders. Shiff is a former healthcare founder. Both came to 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 conscious push for competition.
Risks and Financial Considerations
There are real risks. Participants feed extraordinarily sensitive patient data – confidential conversations about housing, illness, and mental illness – into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. This is not an impractical concern for the vulnerable populations that ACCESS is intended to serve.
There are also financial risks. The track record of CMS innovation programs is mixed. A 2023 Congressional Budget Office analysis found that the CMS Innovation Center increased federal spending by $5.4 billion in its first decade, rather than achieving projected savings. CMS also pays less per patient per month than many participants expected, meaning the bill only works for organizations that have fully automated most of their patient interactions.
Batlivala’s response to the refund concerns is that it is a feature and not a bug. “If you want to build a model that really incentivizes the use of AI, reimbursement rates have to be low,” he told me. “The economics only work if you run a lean, AI-focused operation.”
Future Prospects
Pair Team says it currently has partnerships that give it access to about 500,000 potential patients and that it aims to reach one million within three years.
Healthcare investors have been watching all this closely. Digital healthcare funding this year reached its highest first-quarter total since the pandemic, with AI companies accounting for the bulk of it. Meanwhile, ACCESS has received little attention outside of the health technology trade press.
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