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Medicare’s new payment model is built for AI, and most of the tech world has no idea

Published

2 months ago

May 13, 2026

Preport

Neil Batlivala has spent seven years building a healthcare company that most of the tech industry has never heard of and that serves a patient population most of Silicon Valley ignores. But last month, that work put him at the center of something much bigger.

His company, Pair Team, announced on April 30 it had been accepted into ACCESS, a Medicare program — as one of 150 participants chosen by the Centers for Medicare & Medicaid Services to test what AI-driven medical care could look like at federal scale. The program goes live July 5.

“The government is creating swim lanes for AI innovation in traditionally regulated industries,” he told me over a Zoom call a few days later. “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”

ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — is a 10-year CMS program testing a payment model that rewards health outcomes rather than required activities (like a certain number of check-ins). Participating organizations like Pair Team receive predictable payments for managing qualifying conditions and earn the full amount only when patients meet measurable health goals, like lower blood pressure or reduced pain. It covers diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety.

That payment structure is the real news.

Traditional Medicare reimburses based on time spent with a clinician. There’s no mechanism to pay for an AI agent that monitors a patient between visits, calls to check in, coordinates a housing referral, or makes sure someone picks up their medication. ACCESS creates that mechanism for the first time.

“It’s a payment model transformation,” Batlivala said. “You just couldn’t do this before.”

The first cohort spans a wide range of participants — AI doctor startups, virtual nutrition therapy providers, connected device companies, and wearable makers like Whoop. Batlivala is skeptical of some of them.

“I’m a big fan of wearables, but for a senior who’s struggling with food insecurity, I don’t know how much Whoop is going to be able to do,” he said, adding of his own company, “We’ve been building toward this for five-plus years now.”

Pair Team launched in 2019 with a specific kind of patient in mind: people managing chronic conditions who were also dealing with unstable housing, too little food, or lack of transportation. About a third of Americans fall somewhere in that category.

The company’s premise was that you can’t improve health outcomes without addressing the full context of someone’s life. It now employs roughly 850 clinical professionals, runs what it describes as the largest community health workforce in California, and, per Batlivala, generates revenue above nine figures. It has raised about $30 million, backed by Kleiner Perkins, Kraft Ventures, and Next Ventures.

The model has peer-reviewed evidence behind it. 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 blends medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic disease and it showed strong patient engagement and significant reductions in avoidable emergency and inpatient utilization. Batlivala says one in four hospital visits and one in two ER visits don’t happen when a patient is in his company’s care.

But for years, delivering that level of care required human teams, which limited how fast and cheaply it could scale. Then, about nine months ago, Pair Team deployed a voice AI agent called Flora as its primary patient-facing interface. Flora is available 24 hours a day, handles intake, coordinates referrals, and does the check-ins that keep patients engaged between clinical visits.

The first call that shifted his thinking was with a 67-year-old woman living out of her car, managing PTSD and congestive heart failure. She spoke with Flora for over an hour. “It was both incredible and depressing,” Batlivala told me. “Flora was probably the only ‘person’ she’d talked to in weeks about her situation.” Now, hour-long conversations with Flora are routine. “That’s the companionship piece,” he said. “And it turns out that is truly an intervention.”

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 joined CMS under the Trump administration and their startup backgrounds are reflected in the program’s design: outcome-based payments, direct-to-consumer enrollment, and a deliberate push for competition.

There are real risks. Participants are feeding extraordinarily sensitive patient data — intimate conversations about housing and diseases and mental illness — into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS is designed to serve, that’s not an impractical concern.

There are financial risks, too. 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 during its first decade rather than producing the projected savings. CMS is also paying less per patient per month than many participants anticipated, which means the math only works for organizations that have fully automated most of their patient interactions.

Batlivala’s answer to the reimbursement concern is that it’s a feature, not a bug. “If you want to build a model that truly incentivizes the use of AI, the reimbursement rates have to be low,” he told me. “The economics only work if you’re running a lean, AI-first operation.”

Pair Team says it right now has partnerships in place that give it access to roughly 500,000 potential patients, and that it wants to reach a million within three years.

Healthcare investors have been watching this closely. Digital health funding hit its highest Q1 total since the pandemic this year, with AI companies capturing the bulk of it. But ACCESS has barely registered outside health tech trade press.

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Related Topics:built idea Medicares model payment tech World

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Osun at crossroads, Adeleke, Oyebamiji others will sign peace accord – ODA

Published

3 hours ago

July 13, 2026

Preport

Indigenes of Osun State in the diaspora, under the auspices of the Osun Development Association (ODA), have declared that the governorship candidates of political parties contesting in the forthcoming election in the state will sign a peace accord ahead of the poll.

ODA noted that this is necessary in view of the prevailing situation in the state and to prevent a breakdown of law and order.

The group explained that the current governor and Accord candidate, Senator Ademola Adeleke; the All Progressives Congress (APC) candidate, Mr Bola Oyebamiji; the Action Alliance candidate, Olanrewaju Farinloye; the African Democratic Congress (ADC) candidate, Najeem Salaam; the African Action Congress (AAC) candidate, Esan Olajide; and other candidates will sign the peace pact.

Chairman of ODA’s Leadership and Governance Committee, Dr Tunji Olugbodi, made the declaration in a statement heralding the planned summit where candidates of the political parties will sign the peace accord to prevent violence before, during and after the election.

Olugbodi, in the statement made available to DAILY POST on Monday evening, explained that the state is currently at a critical democratic crossroads.

He said the summit, with the theme, “Speak, Choose, Hold Accountable: Citizens at the Centre of Osun’s Democracy,” is billed to take place in Osogbo because it is necessary to commit all the major stakeholders to a peaceful electoral process.

Olugbodi added that the group believes the state can set a national benchmark for peaceful, credible elections.

The summit is expected to bring all stakeholders in the electoral process under one roof to chart a way forward in order to prevent any uncertainty before, during and after the election.

Olugbodi said, “Osun State is at a critical democratic crossroads. The Osun Development Association (ODA) has finalised arrangements to host the Osun 2026 Democratic Governance, Peace and Electoral Integrity Summit, a high-level civic intervention designed to steer the state’s political discourse toward issue-based campaigning and away from rising tension ahead of the August governorship election.”

ODA Chairman, Dr Segun Aina, in his contribution, noted that the collective participation of all stakeholders is necessary for the forthcoming election.

Health

Nigeria launches food procurement guidelines to tackle unhealthy diets, improve nutrition

Published

3 hours ago

July 13, 2026

Preport

WhatsApp Image 2026 07 13 at 19.24.17.jpeg

The federal government has launched the National Guidelines for Public Procurement of Food and Related Services.

The framework introduces nutrition standards for food purchased with public funds as part of efforts to reduce unhealthy diets and curb the growing burden of non-communicable diseases in Nigeria.

The guidelines, unveiled on Monday in Abuja at an event themed “Public Procurement of Food: Promoting a Culture of National Wellness Through the Food Value Chain,” are expected to influence food served in public institutions, including schools, hospitals, correctional centres and military establishments, by setting evidence-based standards on nutrition, food safety and quality.

Delivering his keynote address at the launch, the Minister of State for Health and Social Welfare, Iziaq Salako, said the initiative marks a shift from viewing public procurement as a routine administrative process to using it as a strategic tool to improve public health and national development.

“When the government demands healthier, safer and more nutritious food, it creates incentives for the entire food system to innovate, improve quality and align with higher public health standards,” he said.

Why it matters

Mr Salako said the government remains the country’s largest institutional purchaser of food, meaning procurement decisions have the potential to influence food production, consumer behaviour and nutrition standards across the food value chain.

According to him, the guidelines establish limits on sodium, sugar and unhealthy fats in foods procured by public institutions while encouraging balanced and nutritious diets.

He said the document complements existing national policies, including the National Guideline for Sodium Reduction, the Trans Fat Regulation and the 2023 National Policy on Food Safety and Quality.

Rising burden of unhealthy diets

Mr Salako noted that unhealthy diets contribute to about 7.2 million deaths globally every year, driven largely by excessive consumption of salt, sugar and unhealthy fats as well as inadequate intake of fruits, vegetables and whole grains.

He revealed that the average Nigerian adult consumes between 3.9 grammes and 4.9 grammes of sodium daily, almost double the World Health Organisation’s (WHO) recommended limit of 2 grammes.

Mr Salako added that increasing consumption of sugar-sweetened beverages has contributed to rising rates of obesity and diabetes, prompting the introduction of the sugar-sweetened beverage tax, while industrial trans fats have also been restricted under Nigeria’s Trans Fatty Acid Regulation.

“These measures are designed to control dietary patterns that fuel the growing burden of non-communicable diseases, placing enormous pressure on health systems, national economies and household incomes,” he said.

Child malnutrition remains a concern

Mr Salako also highlighted the country’s persistent nutrition challenges, noting that malnutrition remains a direct or underlying cause of nearly half of the deaths among children under five years.

He said the Nigeria Mini Demographic and Health Survey found that about four in every 10 Nigerian children under five are stunted, while nearly two million children suffer severe acute malnutrition annually.

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“These are not merely health statistics. They represent profound human capital challenges with significant implications for educational attainment, labour productivity, household prosperity, national competitiveness and sustainable economic growth.”

Implementation key

Mr Salako stressed that the success of the guidelines would depend on effective implementation rather than their launch.

He urged procurement and accounting officers across government institutions to ensure compliance, noting that procurement decisions influence health outcomes, productivity and public confidence in government.

He added that the Federal Ministry of Health and Social Welfare would continue to promote disease prevention through healthier public policies as part of efforts to achieve universal health coverage.