For the first time, the federal government has created a payment mechanism for AI systems that operate on patients between clinical visits. ACCESS—Advancing Chronic Care with Effective, Scalable Solutions—is a 10-year Centers for Medicare & Medicaid Services program that accepted 150 participants in its first cohort, launching July 5. The program represents a fundamental shift in how Medicare reimburses healthcare delivery.
Traditional Medicare payment flows from time spent with a clinician. There is no existing mechanism to pay for an AI agent that monitors a patient, makes check-in calls, coordinates housing referrals, or ensures medication compliance. ACCESS creates that infrastructure.
The program uses outcome-based reimbursement rather than activity-based reimbursement. Participating organizations receive predictable payments for managing qualifying chronic conditions—diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety—and earn the full amount only when patients achieve measurable health goals like lower blood pressure or reduced pain.
Pair Team, one of the 150 accepted participants, exemplifies the model's intended scope. Founded in 2019 and now employing roughly 850 clinical professionals, Pair Team targets patients managing chronic conditions while facing unstable housing, food insecurity, or lack of transportation. The company estimates about one-third of Americans fall into that category. Peer-reviewed research published in the Journal of General Internal Medicine showed that Pair Team's integrated model—blending medical, behavioral, and social care—produced significant reductions in avoidable emergency and inpatient utilization, with one in four hospital visits and one in two ER visits prevented.
Nine months ago, Pair Team deployed Flora, a voice AI agent, as its primary patient-facing interface. Flora operates 24 hours daily, handles intake, coordinates referrals, and conducts check-ins between clinical visits. CEO Neil Batlivala described a formative call with a 67-year-old woman living in her car while managing PTSD and congestive heart failure. She spoke with Flora for over an hour. Batlivala called it "both incredible and depressing," noting that 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 architects of ACCESS—Abe Sutton, Director of the CMS Innovation Center, and Jacob Shiff, Chief AI and Technology Officer of the CMS Innovation Center—are former startup operators. Sutton was previously a venture capitalist at healthcare-focused Rubicon Founders; Shiff is a former healthcare founder. Both joined CMS under the Trump administration. Their backgrounds shaped the program's design: outcome-based payments, direct-to-consumer enrollment, and deliberate emphasis on competition.
Significant risks attend the program. ACCESS feeds extraordinarily sensitive patient data—intimate conversations about housing, disease, and mental illness—into federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations the program targets, that exposure is not merely theoretical.
The CMS Innovation Center's overall track record is mixed. A 2023 Congressional Budget Office analysis found that during its first decade, the Innovation Center increased federal spending by $5.4 billion rather than producing the projected savings. Additionally, CMS is paying less per patient per month than many participants anticipated. The reimbursement mathematics work only for organizations that have fully automated most patient interactions. Batlivala reframes this constraint as intentional design: "If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low. The economics only work if you're running a lean, AI-first operation."