The Centers for Medicare & Medicaid Services (CMS) has introduced ACCESS, a groundbreaking 10-year payment model that rewards healthcare providers based on patient outcomes rather than visits or procedures, creating a new financial framework supportive of AI-based chronic care management.
- ACCESS rewards providers for achieving health outcomes, not visit frequency.
- AI-based care platforms like Pair Team are among the pilot program participants.
- The model aims to transform chronic care by integrating social and medical support.
What happened
On April 30, Pair Team, a healthcare startup focused on supporting patients with complex chronic conditions and social challenges, was selected as one of 150 participants in ACCESS, a new Medicare initiative designed to test AI-driven care models at federal scale. The program is scheduled to go live on July 5.
ACCESS represents a fundamental overhaul of Medicare payments by rewarding health outcomes—such as reduced blood pressure or improved mental health—instead of the volume of clinical services provided. This is the first time CMS has created a payment mechanism that properly funds AI agents handling monitoring, patient check-ins, and coordinated care between visits.
Why it matters
Traditional Medicare reimburses healthcare providers based mainly on time spent with clinicians, offering no financial support for continuous patient engagement through AI or digital tools. ACCESS pioneers a model where healthcare organizations receive predictable payments contingent on meeting specific health objectives, thus facilitating scalable AI-driven management of chronic diseases.
Pair Team, which launched in 2019 and serves patients facing social determinants like unstable housing and food insecurity, exemplifies how integrating behavioral, medical, and social care can reduce unnecessary hospital and emergency room visits. Their voice AI, Flora, supplements human care by providing 24/7 patient interaction, increasing engagement especially in vulnerable populations.
What to watch next
As ACCESS rolls out, the healthcare industry and policymakers will observe how AI-enabled approaches can be scaled cost-effectively while maintaining high patient engagement and improved outcomes. The diversity of participants—from AI doctors to virtual nutrition and wearable companies—will test which models can deliver the best results for chronic care patients.
Key indicators will include reductions in avoidable healthcare utilization, patient satisfaction with continuous AI support, and how the payment model influences investment and innovation in AI healthcare technology. The experience of early adopters like Pair Team could inform future Medicare policy and expand AI’s role in managing complex health and social care needs.