Medicare Just Created a Payment Model That Pays for AI Healthcare. One Startup Has Been Building Toward It for Five Years

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Pair Team, a healthcare company serving patients managing chronic conditions alongside housing instability, food insecurity, and lack of transportation, was selected as one of 150 participants in ACCESS — a new 10-year CMS program that for the first time creates a federal payment mechanism for AI-driven care between clinical visits. The program goes live July 5 and covers diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. The payment structure is the genuinely new development: traditional Medicare reimburses based on time spent with a clinician, meaning there has never been a mechanism to pay for an AI agent that monitors patients between visits, coordinates housing referrals, or ensures medication pickup. ACCESS pays participating organizations for managing qualifying conditions and awards the full amount only when patients meet measurable health outcomes like lower blood pressure or reduced pain — a model that only works economically for organizations running lean, AI-first operations. "If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low," Pair Team founder Neil Batlivala told TechCrunch. "The economics only work if you're running a lean, AI-first operation."Pair Team has been building toward exactly this model since 2019, employing roughly 850 clinical professionals and running what it describes as the largest community health workforce in California, with revenue above nine figures on approximately $30 million in total funding from Kleiner Perkins and others.

Nine months ago, the company deployed a voice AI agent called Flora as its primary patient-facing interface — available 24 hours a day for intake, referral coordination, and between-visit check-ins. A peer-reviewed study co-authored by Pair Team researchers found that patients in its care experienced significant reductions in emergency and inpatient utilization, with one in four hospital visits and one in two ER visits avoided. The company currently has partnerships giving it access to roughly 500,000 potential patients and is targeting one million within three years.

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Federal payment mechanism for between-visit AI care is the structural policy change that makes this commercially viable not just technically possible

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Flora available 24 hours for healthcare coordination, voice AI found its most legitimate use case yet