A Medicare AI Program Designed by Former Startup Founders Is About to Test Whether AI Can Scale Chronic Care

[nihalsari]

ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — is a 10-year CMS program launching July 5 that was designed by two former startup operators now inside the federal government: Abe Sutton, previously a venture capitalist at healthcare fund Rubicon Founders, and Jacob Shiff, a former healthcare founder, both of whom joined CMS under the Trump administration. Their backgrounds are visible in the program's architecture: outcome-based payments rather than activity-based reimbursement, direct-to-consumer enrollment, and deliberate competition among 150 selected participants ranging from AI doctor startups and virtual nutrition therapy providers to connected device companies and wearable makers. Pair Team founder Neil Batlivala was candid about his skepticism toward some participants — noting that for a senior struggling with food insecurity, the value proposition of a Whoop wearable is unclear — while arguing his company has spent five years building the specific operational model that ACCESS rewards.

The program carries real risks alongside its promise. Participants are feeding sensitive patient data — conversations about housing, mental illness, and chronic disease — into federal infrastructure with a documented history of breaches, a concern that is not abstract for the vulnerable populations ACCESS is designed to serve. The financial track record of CMS innovation programs 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 generating projected savings. The reimbursement rates are lower than many participants anticipated, meaning the economics only work for organizations that have automated most patient interactions. Batlivala frames that constraint as intentional design rather than a flaw — a filter that separates genuinely AI-native operators from traditional healthcare companies that added AI as a layer on top of existing cost structures. Digital health funding hit its highest Q1 total since the pandemic this year, with AI companies capturing most of it, yet ACCESS has barely registered outside health tech trade press — a gap between significance and attention that may not last long once July 5 arrives.

[lingriiddd]

Two startup founders designed a federal healthcare program and it actually looks like a startup, makes sense

[lingriiddd]

Whoop wearable for senior with food insecurity, Batlivala said it politely but the point landed