Medicare's ACCESS Program: Payment Model Built for AI Agents, Details Inside

Medicare's ACCESS program (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year CMS pilot that pays for health outcomes, not activities. Traditional Medicare reimburses based on clinician time — no mechanism to pay for an AI agent that monitors patients between visits. ACCESS creates that mechanism. The first cohort of 150 participants goes live July 5, 2026.

How the Payment Model Works

Participating organizations receive predictable payments for managing qualifying conditions (diabetes, hypertension, chronic kidney disease, obesity, depression, anxiety). They earn the full amount only when patients meet measurable health goals: lower blood pressure, reduced pain, etc. This is a shift from fee-for-service to value-based care.

Pair Team's Implementation

Pair Team (raised ~$30M from Kleiner Perkins, ~850 clinical staff) deploys a voice AI agent called Flora as its primary patient interface. Flora handles intake, referrals, and check-ins. A peer-reviewed study in the Journal of General Internal Medicine showed Pair Team's model reduces avoidable ER visits by 50% and inpatient visits by 25%. The company claims one in four hospital visits and one in two ER visits don't happen when a patient is under their care.

Real Patient Interaction

A 67-year-old woman living out of her car, managing PTSD and congestive heart failure, spoke with Flora for over an hour. Hourlong conversations are now routine. Batlivala: "That's the companionship piece. And it turns out that is truly an intervention."

Who It's For

Developers building AI agents for regulated industries (healthcare, insurance) or working on voice-based patient engagement tools. The program's designers (Abe Sutton, Jacob Shiff) are former startup operators.